Please complete and print out one form for each registrant. Return completed form by mail or fax on or before Monday, July 23 to:
Conference Services, Halpern Centre Simon Fraser University 8888 University Drive Burnaby, B.C. Canada V5A 1S6 Fax: (604) 291-3420
I do want to have my name, including my e-mail address, on the Delegate List. (If you do not mark this box, your name will be excluded from the list.)
PLEASE TYPE or PRINT LEGIBLY.
Miss Ms Mrs. Mr. Dr. Prof.
First name (as it will appear on your name badge and the participant list):
Family name:
University:
Department:
Mailing Address:
City:
Province/State:
Country:
Postal/Zip Code:
Phone:
Fax:
Email:
Special Needs (if any):
Audio-visual Supplies/Requirements
I am a presenter; I require the following audio-visual equipment for my presentation (check as required):
Slide projector Overhead projector VHS/VCR Other (please specify):
ICCA 2001 (Industry Day, Monday, July 30) Fee: No charge to ICCBR attendees, otherwise US $150 or Canadian $232.
Early Conference Fee (on or before Friday, June 29) Faculty/Presenter/Other: US $300 or Canadian $462 Student:* US $150 or Canadian $232
Conference Fee (as of Friday, June 29 or on-site) Faculty/Presenter/Other: US $325 or Canadian $500 Student:* US $150 or Canadian $232
* A copy of my valid student card is attached/enclosed.
Please register your interest in attending the workshops by checking the boxes below
These events are included in the Conference Registration Fees. Extra tickets can be purchased for guests. Please indicate the number of guests planning to attend each event:
Welcome Reception at SFU, Harbour Centre: # of Guests
Vancouver Aquarium Dinner: # of Guests x US $50 or Cdn$75 = $
Sunset Dinner Cruise on MV Pride: # of Guests x US $50 or Cdn$75 = $
$ Cdn dollars or $ US dollars
Cheque or Bank Draft (payable to Simon Fraser University) VISA (13 or 16 digits) MasterCard (16 digits)
Sorry, Simon Fraser University does not accept American Express or Diners Club.
Card No.
Expiry Date Issue Date (MasterCard only)
Cardholder's Name (if different from registrant above)
Signature (mandatory for credit card)
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