Registration Form
1999 Annual Computing Conference

Rock Eagle 4-H Camp
October 20 - 22, 1999


A registration form is also available in PDF format, which you may submit via FAX or U.S. mail. Note: Early bird registration fee is $175. Registration fee after 9/17/99 is $200.

Attendee Information
Please complete the following information for each person attending.

Name:
Social Security #:
Title/Department:
Institution:
U.S. Mail Address: (Please include complete address information)
Street:
City:
State:   Zip:
Work Phone:
Fax Number:
Home Phone:
E-mail:

Lodging and Meals

Do you require lodging?

Yes         No

To facilitate lodging room assignment, check appropriate button.

Female         Male

Check the meals you will need provided:

Wednesday Lunch
Wednesday Dinner
Thursday Breakfast
Thursday Lunch
Thursday Dinner
Friday Breakfast

Special physical or dietary requirements?

Yes - Please check here if you have any special physical or dietary requirements which we should know about to help make your stay at Rock Eagle more comfortable. The OITS will contact you prior to the conference to collect this information.

Indicate method of payment
Early Bird Registration Fee: $175
Regular Registration: $200 (after 9/17/99)

Personal Check/Money Order

If your institution pays:

Institutional Check
Purchase Order

PO# (if available):

* For Institutional payment please complete the following:

Business Office Contact:

Street:
City:
State:     Zip:

Authorizing Supervisor:

Payment Instructions
Please DO NOT send payment with registration form. Payment should be made upon receipt of invoice from the OITS. It is imperative that the institutional billing office address be provided. Please submit payment upon receipt of invoice to:

Board of Regents
OITS-Registrations
270 Washington Street, Suite 6069
Atlanta, Georgia 30334

Make PO or check payable to:   Board of Regents, FEI # 58-6002348
   

Registration Cancellations & Verifications

All cancellations are subject to a $25 cancellation fee prior to October 8, 1999. Attendees who register, but do not cancel in writing, are liable and will be charged for the full registration fee. No refunds are available after this date. Please send your cancellation request to Tamara Boyd by e-mail (tboyd@mail.regents.peachnet.edu) or FAX (404) 651-9497.

Substitutions are allowed only with the written permission of the original registrant. Please send your substitution request to Tamara at the email address or fax number above.

 

                               
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