Fields marked with an asterisk (*) are required.
| * Last Name: | ___________________________________________ |
| * First Name: | ___________________________________________ |
| Title: | ___________________________________________ |
| Affiliation: | ___________________________________________ |
| * Address: | ___________________________________________ |
| ___________________________________________ | |
| ___________________________________________ | |
| ___________________________________________ | |
| * Phone: | ___________________________________________ |
| Fax: | ___________________________________________ |
| * Email: | ___________________________________________ |
Registration Fee |
|
| Please check the appropriate fee. | |
| ( ) | Regular ($300.00) |
| ( ) | Student ($150.00) |
| ( ) | Colorado Student ($50.00) |
Tivoli Parking Passes $4.00/each, no in/out: (The Comfort Inn hotel has 24-hours valet parking with in and out privileges for $16 a day.) Purchase prior to March 1, 2003 only if you want the passes to be mailed to you. The Tivoli parking passes will also be sold at the registration desk. |
|
| (enter number of passes) [ ] | Tivoli Parking Pass - no in/out privileges, valid for 24 hours |
Copper Mountain Shuttle: (must be purchased prior to March 1, 2003) |
|
| ( ) | Shuttle - Denver to Copper Mountain Sunday afternoon ($40.00) |
| * Method of Payment: | ( ) Visa ( ) MasterCard ( ) Check |
| * Name on Card: | ________________________________ |
| * Credit Card Number: | ________________________________ |
| * Expiration Date: | ________________________________ |
| * Signature: | ________________________________ |
|
No refunds will be given for cancellations after March 1. Full refunds less a $50 service charge will be given if notified before March 1, 2003. |
|
Check or money order must be in U.S. Funds on a U.S. bank written to: |
|
| IMACS, Front Range Scientific Computations | |
| If paying with a EuroCheque, please add $6 to your fee for bank processing. | |
Please fill and fax to (303) 556-8550 Attn: IMACS
or print and mail a copy to
Front Range Scientific Computations, Inc.
Attn: Cathy Lee
1390 Claremont Drive
Boulder CO 80305