2009 Conferences on Intelligent Computer Mathematics
                            Registration Form
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                   Please fill in and FAX to +1 519 661-3515
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I. PERSONAL INFORMATION

First Name: _______________________  Last Name: _______________________________

E-mail address: ___________________  Telephone: _______________________________

E-mail again:   ___________________        Fax: ________________________

Institutional affiliation:        _____________________________________________

Institutional mailing address:    _____________________________________________

Are you a full time student or post-doctoral fellow? (Yes or No) _______
You will be required to show proof of status at the conference.

II. REGISTRATION

You must pay the base registration PLUS the per-day registration fees.

IIa. BASE REGISTRATION:
                        by June 5     by June 30        on Site
   Student/Postdoc      CAD 175       CAD 400           CAD 400
   Regular              CAD 325       CAD 400           CAD 400

   Enter the correct base registration amount from the table:       ______ (A)

IIb. PER DAY REGISTRATION:
                        by June 5     by June 30        on Site      
   Student/Postdoc      CAD 30        CAD 50            CAD 75
   Regular              CAD 50        CAD 50            CAD 75

   Choose the days you are attending:  July 6 7 8 9 10 11 12.

   _____  (number of days) x  ______ (Amount from table)  =         ______ (B)

IIc. Registration includes one banquet ticket.
     How many extra banquet tickets do you need? ______ x CAD 45 =  ______ (C)

IId. Registration includes one proceedings.
     How many extra proceedings do you need?     ______ x CAD 96 =  ______ (D)



                                              Subtotal (A+B+C+D)    ______

                Canadian Goods and Services Tax (5% of Subtotal) +  ______

                                                        TOTAL    =  ______
III. PAYMENT

Please charge my credit card the amount  CAD ________ (copy TOTAL).

Credit Card Type (choose one)   VISA    Mastercard

Credit Card Number       ____________________________

Expiration Date          Month _____  Year _____


Signature                ____________________________

GST Registration number R108162587.