Please print this form and provide all the the requested information.
|Street Address:|| |
|State or Province and Country:|| |
|ZIP or Postal Code:|| |
|E-mail address:|| |
|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
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:|| |
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
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.