Name: (for badge)

E-mail:

Address:

Conference Fee - Check one (1):

Full (includes lunches and coffee breaks) $50

Following day[s] only (includes coffee and lunch). Check as applicable:

Thursday, 11 June, afternoon No Charge

Friday, 12 June (day only / lunch & coffee breaks) $25

Saturday, 13 June (day only / lunch & coffee breaks) $25

Friday night self-pay restaurant dinner; no charge, but indication
to attend requested to determine reservations

Membership CNRS (desirable, but not obligatory) - New / Renew:

Canadian: Individual $70 / Student $25

International: Individual $80 / Student $35 / NASOH $30

Payment - [please use printed form for payment by cheque.]

Visa: Exp:

MasterCard: Exp:

Comment: