2009 Conferences on Intelligent Computer Mathematics
Registration Form

Please fill in and FAX to +1 519 661-3515

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.