AMOTIA 1st Annual Conference, Registration Form.doc - DOC - DOC
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CONFERENCE ON DESIGNS CODES AND GEOMETRIES MARCH 28, 2010 – APRIL 2, 2010 CONFERENCE REGISTRATION FORM Send Completed Registration Forms to: Qing Xiang email@example.com 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 firstname.lastname@example.org 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.