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Download the
Registration form (word)
Download the
Registration form (pdf)
REGISTRATION FORM
Name:__________________________________________________________________________________
Address:________________________________________________________________________________
____________________ _______________________
__________________________________________
Telephone Fax: e-mail
Registration |
Amount |
On or before March 31, 2015 - US $225.00, (Students: US $125.00) | $____________ |
After April 01, 2015 - US $250.00, (Students: US $150.00) | $____________ |
Additional Guest Banquet Tickets :$ 30.00 X ____ | $____________ |
Dormitory: May 26 - 30, 2015 $100.00/person | $____________ |
Total enclosed: |
$____________* |
(*US funds only, MASTER/VISA/DISCOVER/AMEX/Bank draft/US personal checks/International Money Orders: Make checks payable to International Conference-Morehouse College)
I plan to stay in:
[ ] Morehouse dormitory; [ ] listed hotels; [ ] on my own;
[ ] Card name: VISA/MC/AMEX/DISCOVER (Registration fees is non refundable)
Card number:___________________________________________ Ex. Date:
____________________
Name on the Card: ______________________________________________
Signature: ______________________________________________
Return To:
Mail
Check (Or) Filled Original credit card payment form to:
Organizing Committee, Attn: M. Sambandham
ICDSA7-ICNPSC5, Department of Mathematics, Morehouse College, Atlanta, GA 30314, USA.
Or Fax Credit Card payment to:
Attn: ICDSA7-ICNPSC5, Office of the Business and Finance, Morehouse, FAX: (404)
653-7740
(and inform by an e-mail to icdsa7@yahoo.com that you have faxed the registration)
(Scanned Filled Registration Copy Sent by e-mail is Not Acceptable)