CESC 2007 Registration Form April 10-12, 2007 Omni Shoreham Hotel Personal Information (* denotes required information) *First Name *Last Name *Affiliation *E-mail *Phone Fax Note: If the registration fee is paid by credit card, the address below must match the billing address for the credit card. *Street Address 1 Street Address 2 *City *State *Zip Payment Information Check Enclosed ( Payable to KRL Science Management/CESC 2007 ) I wish to pay by the following Credit Card: MasterCard Visa American Express Credit Card Number Card Identification Number Name as it appears on Credit Card Expiration Date Information: Registration Fee Advance registration fee: $375.00 (US dollars) Advance registration deadline: March 28, 2007 . All advance registration payments are to be made by credit card, check or money order, and registration is not complete until payment is received. If space is still available, registration fee after March 28, 2007: $425.00 (US dollars) If not registering online, fax or mail your registration form and payment, if applicable, using the following information: Fax: (515)-956-3699 Mail: CESC 2007 Conference Registration 1609 Golden Aspen Drive, Suite 101 Ames, Iowa 50010 Cancellation Policy All changes and cancellations must be submitted in writing either via e-mail to email@example.com or by regular mail to the address listed above. Cancellation requests must be received on or before March 28, 2007 in order to qualify for a refund less a $25.00 processing fee. A $75.00 processing fee will be charged for cancellations received between March 29, 2007 and April 9, 2007. Refunds will be processed based on the original form of payment within 30 days after the close of the meeting. No-shows will be charged the full registration fee. Credit Cards CESC 2007 accepts Visa, MasterCard, and American Express. To Find Card Identification # (this number is recorded as an extra security precaution): American Express: Card Identification number is the 4-digit, non-embossed number printed above your account number on the face of the card. Visa: Card Identification number is the 3-digit, non-embossed number printed on the signature panel on the back immediately following the Visa card account number. MasterCard: Card Identification number is the 3-digit, non-embossed number printed on the signature panel on the back of the card.