The 2002 Conference - Online Registration Form

Name (Last, First)
Organization
Street Address
City
State
Country
Zip or Postal Code
Telephone
Fax
E-Mail Address

Fees (in U.S. dollars):

Registration Fee (for pre-registration)*, Regular $ 100; Registration Fee, Full Time Student $ 80
: Lunch Friday June 21 $ 15; Lunch Saturday June 22 $ 15; Banquet Saturday June 22 $ 40 (beverages not included)
: Total in U.S. dollars; *Registration at the door in Salt Lake City will be $ 120.

Method of Payment

a) Credit Card Type of Card     VISA MasterCard EuroCard Here are the details of my credit card for immediate on-line registration: Name on Card (print) Number Expiration Date Birthdate (mandatory: month-day-year) Signature (not needed for online registration):_____________________________ I will mail the details of my card with a printed and signed copy of this form b) I want to register now and am sending a printed and signed copy of this form with details of my bank draft ___
If you do not register online, please fax or mail registration forms (including details of your credit card) to: CESNUR Via Confienza 19 10121 Torino, Italy Fax: +39-011-541905 If you select option (b) please mail or fax forms to CESNUR, and send bank drafts to CESNUR PIEMONTE as follows Name of bank: Deutsche Bank, Via Arcivescovado 7, 10121 Torino, Italy Bank codes: Account number: 33719 ABI: 3104 CAB: 01000

The CESNUR 2002 Conference - Salt Lake City and Provo (Utah) June 20-23, 2002