SE:E&P'98 Advance Registration Form

PLEASE PRINT
Name:_________________________________________ Position:________________________________________
Organisation:_________________________________________________________
Address:_____________________________________________________________
City:______________________________________ Country:___________________________________
Telephone: (_______)_________________Fax:(______)___________________
Email:________________________
 
r I wish to participate in the workshop sessions (Please indicate suggested topics). 
r Please send me university (St. Margaret's College) accommodation information. 
r Please send me hotel/motel accommodation information. 



PAYMENT

Full registration (includes Proceedings and Conference Dinner)
Payment received before 8 December 1997 $425  $____________ 
Payment received after 8 December 1997 $495  $____________
Student registration (sessions only)
(Verification of full-time student status is required) $ 95  $____________ 
 

Accommodation St. Margaret's College (single room, breakfast included)

Arrival Date: ___________  Arrival Time: ___________ 
Departure Date: _________  Departure Time: _________ 
____ nights at $50/night:  $____________ 
Social Functions
Conference Excursion (includes dinner)
Dunedin/Otago Site-Seeing (27 Jan 1997)____ tickets at $75/ticket  $____________ 
Conference Dinner (included in registration fee for participants) 
____ additional tickets for accompanying persons at $40/ticket: $____________ 
TOTAL $ ____________ 
Payment of registration fees should be made by cheque or money order in New Zealand dollars, payable to the University of Otago. A refund, less an administration charge of $50, will be made on cancellation of any booking provided it is received by 8 December 1997. Thereafter the full amount paid will be forfeited.

I enclose a cheque for ______________ payable to the University of Otago for $ _______

If you wish to pay by credit card, please complete the following:

r Visa r MasterCard Expiration Date:______/______/______
Print name (exactly as shown on card)_____________________________________
Card Number:________________________________________________________
Cardholder's signature:________________________________ Date: ___________

Please mail a copy of this completed form to:

SE:E&P'98 
Information Science Department  
University of Otago 
P.O. Box 56 
Dunedin, New Zealand