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.