2000 SMB Annual Meeting Registration Form

SMB 2000 Registration Form

Please print this form and provide all the the requested information.

Participant information:

Name:

Department:

Organization:

Street Address:

City:

State or Province and Country:

ZIP or Postal Code:

E-mail address:

Payment information:

Credit Card Number:

Expiration Date:

Card Type: ___Visa ___Master Card ___American Express

On or before June 30, 2000, the conference fee $150 ($50 for students) plus social events.
After June 30, 2000, the conference fee $225 ($100 for students) plus social events.
Indicate the social events you would like to attend:

___Student Lunch ($5) ___Banquet ($35) ___Albion Basin Hike($10) ___Park City Tour($39)

Total fees:

Signature:

Mail or FAX this form to:
University of Utah Conferences and Events
1901 E. South Campus Drive, Rm 1215
Salt Lake City, UT 84112-9359

FAX 801-581-3165
Please excuse the inconvenience of FAXing or mailing this form. We could not easily guarantee the security of your financial information with for web-based submission of registration forms.

Participant information:
Name:
Department:
Organization:
Street Address:
City:
State or Province and Country:
ZIP or Postal Code:
E-mail address:
Payment information:
Credit Card Number:
Expiration Date:
Card Type:	___Visa ___Master Card ___American Express
On or before June 30, 2000, the conference fee $150 ($50 for students) plus social events. After June 30, 2000, the conference fee $225 ($100 for students) plus social events. Indicate the social events you would like to attend:
___Student Lunch ($5) ___Banquet ($35) ___Albion Basin Hike($10) ___Park City Tour($39)
Total fees:
Signature: