WSC 95 Conference Registration Form

WSC '95 Conference Registration Form

Please print and send with your registration fee to

WSC '95 Registration, c/o EPIC Management
8720 Red Oak Blvd. Suite 224
Charlotte, NC 28217
Phone: (800) 220-9647 (within the US) or (704) 529-1725
Fax: (800) 220-9648 (within the US) or (704) 558-4753

Registration form must be received by November 17, 1995.

Please print or type.

Name: __________________________________________   Method of Payment:
  
Organization: __________________________________   __(CK)Check# ______  __(PO)Gov't Form 1556

Street Address: ________________________________   __(AM)Am.Express __(MC)Mastercrd __(VI)Visa

City: __________________ State: ___ Zip: _______   Card Number: ______________________________ 

Country: _______________________________________   Expiration Date: __________________________

Phone: (___) ___________ Fax: (____) ___________   Name on Account: __________________________ 

                                                   Authorizing Signature: ____________________ 
Please check here if you are a: __Presenter __Session Chair

Please check your member status (check all that apply):
__ASA  __ACM  __IEEE  __INFORMS  __SCS  __IIE      
Member #: __________________                       Students only:
                                                                 __________________________________
Early Registration (through November 3, 1995)                    Faculty member's name
__(ME)$190 Member  __(NE)$250 Nonmember  __(SE)$30 Student       
                                                                 __________________________________
Standard Registration (after November 3, 1995)                   School name
__(ML)$230 Member  __(NL)$290 Nonmember  __(SL)$30 Student         
                                                                 __________________________________
Please indicate if you have any special needs: ______________    Faculty member's signature

Additional Information:

No corporate purchase orders or cash accepted.
Member rate applies to members of any sponsoring society.
Registration fees are transferable for WSC '95.
No refunds will be made after November 17, 1995.
Registration form must be received by November 17, 1995.
On-site registration is available at the standard registration rates.
All registrants will receive one copy of the Proceedings. Extra copies will be available on-site for $35 each while supplies last.
Student rate applies only to full-time students. A faculty signature is required to certify student's enrollment status

Return to WSC '95 home page.