ATTENDEE REGISTRATION FORM: SEDE-2008
Please complete this form (TYPE or PRINT)
and return by MAY 16, 2008 for early registration rate.
FIRST Name: _________________MI
_____ LAST Name: ___________________________________________
Title ( Dr / Mr / Mrs / Ms ): _________Position:
________________ Organization:
______________________
Address:
___________________________________________________________________________________
City:
___________ State/Province:
____________ Zip/Postal Code _____________ Country:
____________
Telephone: ___________________________ Fax:
______________________________________________
E-mail: ______________________________ List your areas of interest:
_____________________________
PLEASE NOTE: To
become a NEW ISCA member at this time, or if you would like
to renew your ISCA Membership for 2008, please check both the ISCA MEMBER RATE *
and
the 2008 ISCA MEMBERSHIP** boxes below when you register.
| EARLY REGISTRATION FEE (RECEIVED BY MAY 30, 2008) | ||
| ISCA MEMBER | $450.00 | _________ |
| NON-MEMBER | $550.00 | _________ |
| 2008 ISCA MEMBERSHIP | $100.00 | _________ |
| * STUDENT (includes ISCA student Membership) | $ 25.00 | _________ |
| * The luncheon banquet and CD Conference Proceedings are not included with student registration but may be purchased separately. | ||
| REGISTRATION FEE (RECEIVED AFTER MAY 30, 2008) | ||
| ISCA MEMBER | $500.00 | _________ |
| NON-MEMBER | $600.00 | _________ |
| 2008 ISCA MEMBERSHIP | $100.00 | _________ |
| * STUDENT (includes ISCA student Membership) | $ 25.00 | _________ |
| ADDITIONAL FEES: | ||
| Additional Luncheon Ticket: | $ 50.00 / each | _________ |
| Additional SEDE-2008 CD Proceedings : | ||
| ISCA member | $ 50.00 / each | _________ |
| Non-member | $ 75.00 / each | _________ |
| Proceedings (BOOK format) | $ 50.00 / each | |
| TOTAL: | _________ | |
METHOD OF PAYMENT: __Check Enclosed __Money Order ___Visa ___MasterCard
___American Express
Payment may be made by check, International money order (in U.S. dollars drawn
on a U.S. Bank
made payable to ISCA), or credit card in U.S. dollars.
(Credit Card No.): __ __ __ __ - __
__ __ __ - __
__ __ __ - __ __ __
__
Expiration Date ________/_______ Security Code on Back
of Card ___________________
Print Name as it appears on Card:
__________________________________________________
ZIP/POSTAL CODE of billing
address: ______________________
(REQUIRED)
____________________________________________________
(Signature
REQUIRED)
(PLEASE INDICATE YOUR CHOICE BELOW)
I plan to attend the complimentary
LUNCHEON on JULY 1, 2008
¨Yes
¨
No
Special dietary requirements: __________________________________
Please FAX to: (919) 467-3430 ,
scan and email to
isca@ipass.net,
or mail this completed form along with
your Registration Fee to:
ISCA - SEDE-2008 Conference
975 Walnut Street, Suite 132
Cary, NC 27511-4216
If you have any registration questions, please contact
Mary Ann Sullivan at: Telephone: (919) 467-5559; Fax: (919) 467-3430 or Email: isca@ipass.net
ISCA EIN Number: 56-1799522