Advance Middleware Services* REGISTER TODAY!     

(This form in PDF and Word format)

 

Register by fax, mail, or e-mail using the form below. Payment must be guaranteed (i.e. credit card or purchase order) at time of registration.  Registration cancellations after June 15, 2003 are not refundable.  Substitutions may be made at any time.

 

Name: __________________________________________________________________

                    Last Name/Family Name                             First Name

 

Affiliation: ______________________________________________________________

 

Address: ________________________________________________________________

 

City/State/Zip/Postal Code/Country: _________________________________________

 

Phone: _____________________________Fax Number: _________________________

 

E-mail Address: __________________________________________________________

 

WORKSHOP TUTORIAL REGISTRATION FEE: (includes proceedings, refreshment breaks and a one year subscription to Cluster Computing Journal)

 

Active Middleware Services:  Before June 1, 2003………….$150

                                                After June 1, 2002……………$200

                                                Student (with valid ID)………$100

 

TOTAL ENCLOSED                                                            $_______________

 

Please make checks payable to:  The University of Arizona Foundation

NOTE:  Registration fees are not a tax-deductible contribution.  However, they may be deducted as a business expense.  Check with your accountant or tax advisor.

 

If you wish to use your VISA or MASTERCARD for registration:

 

Card # _______________________________________________ Exp. _________

Signature _____________________________________________ Date _________

 

The University of Arizona accepts AMERICAN EXPRESS or VISA Debit Cards:

 

Card # _______________________________________________ Exp. _________

Signature _____________________________________________ Date _________

 

Persons with a disability may request a reasonable accommodation, such as a language interpreter, by contacting Engineering Professional Development, 520-621-3054.  Request should be made as early as possible to allow time to arrange the accommodation.  I have the following special needs/requirements:

________________________________________________________________________

________________________________________________________________________

 

Mail/Fax or e-mail this form to:

  Engineering Professional Development

  The University of Arizona

  1224 N. Vine Avenue

  Tucson AZ 85719-4552 USA

  Phone: 520-621-3054

  FAX:   520-621-1443

  E-mail:  epd@engr.arizona.edu