Printable Registration Form

Please make a copy of this form for your records

Conference Dates: August 19 - 23, 1995
Location: University of Victoria
Early Registration Deadline: July 15, 1995
COEU X 394

Name: (nametag copy) _______________ (first) _______________ (last)
Organization: (nametag copy) ______________________________
Address: _____ (Home) _____ (Business)
__________________________________ (suite number/street/RR#)
__________________________________ (city)
________________ (province/state) _________ (zip/postal code)
Telephone: (Business) ____________ (Residence) ____________
Fax: _____________ E-Mail: _____________

FULL Conference Registration includes reception, conference sessions and materials, BBQ dinner, all coffee breaks. The University of Victoria GST Registration Number is R108162470.

• K01 _____ Pre-conference Tutorial - Aug 19 - $107.00
  ($100 + $7.00 GST)
  
• K02 _____ Early Registration - before July 15, 1995 - $187.25
  ($175.00 + $12.25 GST)
  
• K03 _____ Late Registration - after July 15, 1995 - $214.00
  ($200 + $14.00 GST)
  
• KO4 _____ Proceedings - $$16.05
  ($15 + $1.05 GST)
  

HALF and ONE DAY Conference Registration is now available. This does not include the reception, or BBQ dinner.

• KO5 _____ Monday AM - Aug 21 - $80.25
  ($75 + $5.25 GST)
  
• KO6 _____ Monday PM - Aug 21 - $80.25
  ($75 + $5.25 GST)
  
• KO7 _____ Tuesday AM - Aug 22 - $80.25
  ($75 + $5.25 GST)
  
• KO8 _____ Tuesday PM - Aug 22 - $80.25
  ($75 + $5.25 GST)
  
• KO9 _____ One Day/Monday - Aug 21 - $133.75
  ($125 + $8.75 GST)
  
• KO10 _____ One Day/Tuesday - Aug 22 - $133.75
  ($125 + $8.75 GST)
  
• KO11 _____ BBQ Ticket - Aug 22 - $21.40
  ($20 + $1.40 GST)
  

The University will publish a mailing address list of delegates to this conference. This delegate list will be provided to all registered participants, and may be used for future promotional mailings, as deemed appropriate by the Organizing Committee. Please CHECK the following if applicable.

• K87 ______ I do NOT wish to have my address published in the Delegate List
  
• K88 ______ I do NOT wish to receive future promotional mailings
  

TOTAL ENCLOSED: $__________

Credit Card Information In order to use a credit card as payment for these fees, please CHECK the name of the card you are using. Faxed registrations are payable only by credit card.

MASTERCARD _____ VISA _____ NB: No other credit cards are accepted.
Account #: ____________________________ Expiry Date: ___/___
Authorized Signature: _________________________ Date: ____________

Please complete registration form and mail it with your cheque or money order made payable to the University of Victoria or fax with complete credit card information to:

Telecommunities '95 Conference Management
Division of Continuing Studies
University of Victoria Box 3030 MS 8451
Victoria, BC, CANADA V8W 3N6
Fax: (604) 721-8774 E-mail: icnc@uvcs.uvic.ca
For further information please call (604) 721-8470.

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