Conference Registration Form

send to: Prof. Carl Leinbach, Dept of Math, Gettysburg College, Gettysburg, PA 17325, USA
fax (+1)717-677-9764 or (+1)717-337-6638, email: leinbach@cs.gettysburg.edu


Name: 										

(Mailing) address: 								

Home phone: 			 Business phone: 				

E-mail: _________________________________ Fax: 			


* Conference Fee (includes conference talks, 2 workshops, Wednesday tour, & Friday Battlefield tour): $150.00 if paid by May 15, 1998 ($170.00 thereafter):			

* (Optional) fee for accompanying individuals for day tour, Wednesday tour, & Battlefield tour:
__	 accompanying persons over age 12 @ $100 if paid by May 15, 1998 ($110 thereafter) 		
__	 accompanying persons under age 12 @ $50 if paid by May 15, 1998 ($55 thereafter)

Names & ages of all accompanying individuals: 							

* Wednesday Tour registration for whole party: 1st choice: ___    2nd: ___    3rd: ___ 
Meal preference for Tour #1: __ prime rib or beef / __ chicken / __ fish

* Friday Battlefield Tour registration for whole party: Yes: ___    No: ___ 

* Thursday tour for accompanying individuals registration: Yes: ___    No: ___ 

* Workshop registration: 1st choice: ___    2nd: ___    3rd: ___    4th: ___    5th: ___

* Lodging:  __ I made my own reservations in the following hotel: 				
__ Pls book a room in the Gettysburg College Dormitory (no maid service, linens provided)
        for the following persons (# and names): ____________________________________
        for the following dates: 7/13: ____,  7/14: ____,  7/15: ____,  7/16: ____ 
                   (earliest check in is 7/13 at 3pm, latest check out is 7/17 at 11am)
        __ single room @ $55 per person per day (incl. 3 cafeteria meals/day) ltd. 			availability!		
        __ double room @ $45 per person per day (incl. 3 cafeteria meals/day)	 	

* Transportation from airport to Gettysburg:  __ I will arrange own transportation.
__ Pls book a charter bus service from and to the following airport:
       ___ Washington-Dulles,  ___ Baltimore-BWI,  ___ Harrisburg 
       on 7/13 my/our flight no. _____ arrives at ______ hours.
       on 7/17 my/our flight no. _____ departs at ______ hours (should be after 6pm).
       __ persons @ 25 .......................................................................................................................................			

* Total: ..................................................................................................................				

* Payment (Conference registration accepted only with accompanying payment):
	Check enclosed made payable to "1998 DERIVE/TI-92 Conference".
	Charge my credit card:   __ MasterCard,  __ VISA
Card no. 				 exp. 		signature: