The 18th International Workshop on Qualitative Reasoning

August 2, 3, & 4

Evanston, Illinois USA

REGISTRATION FORM

ON-LINE REGISTRATION CLOSES MONDAY, JULY 26th (5pm your local time). All Registration forms received after this date are considered LATE REGISTRATIONS and the amount charged will be $250 (instead of $200) per person.

(1) PLEASE PRINT OUT THIS FORM AND FAX IT TO THE NUMBER LISTED AT THE END*.

(2) PLEASE READ ENTIRE FORM AND CHECK THE INFORMATION YOU WILL SEND US.

(3) PAYMENT IN US DOLLARS ONLY.

Contact details (please type or print in capital letters)

First Name:

Last Name:

Title:  

Organization:

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Email:

Phone:

QR04 WORKSHOP INFORMATION

*August 1st, Sunday: Cocktail Reception from 7-10pm for those available                     

*August 2nd, 3rd, 4th

Registration includes a copy of the workshop proceedings, food and beverages during breaks all three days of the workshop, and the Tuesday excursion (Architectural boat tour on the Chicago River with box lunch, dinner, and a show at Second City, Chicago’s best improvisation group).  Other meals and hotel accommodations are not included. 

Please let us know if you are:

Vegetarian  Disabled    Other restriction:

REGISTRATION FEE: $200

REGISTRATION FEE AFTER JULY 26th: $250

Please, let us know if you will join us on Sunday, August 1st for the cocktail reception:    Yes                  No

Amount due for the registration fee : $   (Total A)

Extra copies of the proceedings?

   Yes                  No

Number of extra copies    x   $20 /copy = $ (Total B)

TOTAL AMOUNT DUE:

Total A +Total B = $ Grand Total

CREDIT CARD DETAILS

Card Holder Name(as it appears on card):

 

Billing Address of Credit Card: 

 
Credit Card Number:  

     

Security Number Code:
*the last three digits printed on the back of your credit card
     
Expiration date:

 month/year
TOTAL AMOUNT DUE (Grand Total) This amount will be charged to your card:

$

Today's date:

/    /
day    month   year
Signature (as it appears in the card):

PAYMENT DUE BY July 26, 2004 at 5pm (your local time)

* Please, print and send this form by fax to: (+1) (847) 491-5258

Your payment will show on your credit card receipt. We will acknowledge receipt of your form via email and will send further information via email. See you in August!