REGISTRATION FORM

\n"); print("Copper Mountain, Colorado, $Dates, $Year\n

\n\n"); ?> Please use the address you want to appear on the attendee list. 

Name ________________________________________________
 
Affiliation _________________________________________
 
Street Address ______________________________________
 
_____________________________________________________
 
_____________________________________________________
 
Country        ______________________________________
 
email address  ______________________________________
 
phone number   ______________________________________
 
before $DeadlineEarlyReg, $Year\n");
printf("\t(   ) SIAM Member \$%s.00\n", $FEE{"siam"});
printf("\t(   ) Non-SIAM Member \$%s.00\n", $FEE{"nonsiam"});
printf("\t(   ) Student \$%s.00\n", $FEE{"student"});
 
print("\nRegular Registration Fee\npostmarked ");
print("on or after $DeadlineEarlyReg, $Year, or paid at conference\n");
printf("\t(   ) SIAM Member \$%s.00\n", $FEE{"siam_late"});
printf("\t(   ) Non-SIAM Member \$%s.00\n", $FEE{"nonsiam_late"});
printf("\t(   ) Student \$%s.00\n", $FEE{"student_late"});
?> 

Method of Payment
	(   )  Check or money order enclosed
 
Checks written to:   Copper Mountain Conference
Must be in U.S. funds drawn on a U.S. bank.  If paying with
a EuroCheque, please add $6 to your fee for bank processing.
 
	(  ) VISA or MASTERCARD only  (No Amer.Expr.)

	Name on Card_________________________________

	Card # ______________________________________
			Exp. Date ___________________

	Signature____________________________________
	(if sending by email no signature necessary)