AMOTIA 1st Annual Conference, Registration Form.doc - DOC - DOC

							     CONFERENCE ON DESIGNS CODES AND GEOMETRIES

                          MARCH 28, 2010 – APRIL 2, 2010
                                  CONFERENCE REGISTRATION FORM
Send Completed Registration Forms to:
Qing Xiang
xiang@math.udel.edu
Fax: 302-831-4511
CC Completed Registration Forms to:
Lisa Doak
LDOAK@UDEL.EDU
Fax # 302-645-4113

First Name ____________________________ Last Name _________________________________

Title _________________________________ Badge Nickname _____________________________


Affiliation ______________________________________________________________________________


Street Address __________________________________________________________________________


 City _________________________________ State ______________ Zip Code __________


Telephone _____/_______‐___________ Fax ________/_______‐___________


Email ___________________________________________________________ Cell________/_______‐

___________



                        PACKAGE OPTIONS
Includes; parking, 5 night lodging, meals, gratuities, and conference.
Double Occupancy (March 28- April 2, 2010)                           $499.00/per person

Single Occupancy (March 28- April 2, 2010)                           $675.00/per person

Spouse (not attending conference) Meal Plan                          $125.00 (5 Breakfast & 2 Banquets)



Spouse Name _______________________ Badge Nickname _____________________________


TOTAL COST $_______________                           Credit Card Type: _________
Credit Card Number: ______________________________________
3 digit CCV _______
Billing Address Zip Code __________
Expiration Date _____/ ______
                              FREE TIME ACTIVITIES FORM


                              nd
_____ Shopping in Lewes at 2 Street Shops & Historical Tour/Zwaanendael Museum

_____ Cape Henlopen State Park ‐nature activities, beach, bay, biking, kayaking (4 Seasons!)

 _____ Lewes Maritime Trail

_____ Rehoboth Beach Boardwalk, shopping and museum

_____ Wine Tasting at Nassau Valley Vineyards

_____ Spa treatment, massage, and other personal time treats

_____ Dolphin Watch Cruise (Seasonal)

---------Cape May Lewes Ferry and Cape May NJ Day Trip

Full payment is due at time of registration. A confirmation will be sent to you
automatically. Please be sure to check your e-mail box for important travel and
check in information. Detailed receipts for conference package are available upon
request at the Virden Center Purser’s Office. A $75 cancellation fee may apply after
March 15, 2010.

For more information regarding the conference details and schedule please contact
Qing Xiang
xiang@math.udel.edu
Phone: 302-831-1868
Fax: 302-831-4511

For more information on meals and lodging, call
Lisa Doak
LDOAK@UDEL.EDU
Phone: 302-645-4103
Fax # 302-645-4113

Please complete registration form and return to Both Qing Xiang and Lisa Doak by
March 8, 2010. You may print form and fax back or overwrite, save, and attach to
e-mail.