HFM Conference Registration Form



Surname:				First Name
Title:				Position:
Organization:
Mailing Address:
City:				Province/State:
Postal Code:				Country:
Day Telephone:				Fax:
Home Telephone:				E-mail:
Special Needs:				Gender:
REGISTRATION FEES

Before May 10	$350 CDN		$250 US	Total Amount Payable:
After May 10	$400 CDN		$285 US	Total Amount Payable:

Banquet (location Canadian Clay & Glass Gallery, Waterloo)

# of Persons	X $25 CDN		X 20 US	Total Amount Payable:

ON CAMPUS ACCOMMODATION INFORMATION:

Room Type:
If Double Occupancy, name of roommate
Do you require a ground floor room?

Conference Name:

Arrival Date:				Arrival Time:
Departure Date:				Departure Time:

COST SUMMARY

Accommodation Total - if staying on campus (Canadian Funds)
Total Cost (Add accommodation total and registration total)

Payment Method:

Credit Card #:				Expiry Date:

If paying by cheque:		Make cheques or money order payable to the University of Waterloo

If you are mailing your cheque and registration:	Print the registration form and send it with your payment to:				University of Waterloo Conference Centre, Ron Eydt Village Box 16610, Waterloo, ON, Canada N2J 4C1

If you would like to fax your registration:			Please print the registration form and send it with your credit card information to: (519) 746-7599

Enquiries:	(519) 884-5400			E-mail enquiries:	accombook@uwaterloo.ca

UW Conference Centre Web Site:				http://www.conferences.uwaterloo.ca

Full Name:				Date:

Cancellation Policy:	Full refunds will be given if requested in writing to the above address or faxed to (519) 746-7599 and must be received by May 30, 2000. A charge of $50 Canadian will be made for cancellations received after May 30 to June 10. No refunds can be made on cancellations made after June 10, 2000. Substitutions are permitted. It is suggested that you keep a photocopy of the completed registration form.

	By electronically submitting this information, you are signalling your acceptance of credit card payment and terms outlined above regarding cancellation.

Airways Transit Information
Off Campus Accommodations