FPSAC'06 - Online Registrant Information Form

Registrant Information Form

All participants are asked to complete the following form in order to provide their personal information to the conference organizers.

Payment should be made by cheque (and postal mail). Upon completing the form below, you will be taken to an "off-line" payment page with instructions. If you are unable to pay by check or money order, then please contact the Conference Organizers in order to make other arrangements.

Registration requests will be taken until the start of the conference.

Title:
Family Name (Surname):
Given/First Name:
Preferred Name for Badge:
University/ Organization:
Department:
Mailing Address:	Enter Your Mailing Address Here
Postal Code:
Country:
Email Address:
Telephone Number:
Fax Number:
Registration Type:	Regular (currently US$325) Student (currently US$170)
Tickets for Conference Banquet (US$70 each):
Are You Vegetarian:	Yes No
Other Dietary Restrictions:	Enter Other Dietary Restrictions Here
Total Cost of Registration: US$

WARNING: DO NOT USE special characters like # or & in the fields above. This will cause unexpected consequences!

If you have any problems submitting your information electronically, then please email the FPSAC'06 webmaster.