UW Extension Registration Form | |
Information Architecture Summer Institute |
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June 23–27, 2008 |
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_________________________________________ Name (last) |
_________________________ Name (first) |
___ M.I. |
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_________________________________________ Title | ________________________________ Institution/Organization |
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_________________________________________________________________________ Mailing address |
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______________________________________________ City |
_________ State |
________________ Zip |
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____________________________________ Social Security Number* |
____________________________________ Date of Birth |
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____________________________________ (Area code) Daytime phone |
_____________________________________ (Area code) Evening phone |
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____________________________________ E-mail Address |
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Yes, I wish to register for Information Architecture Summer Institute (Reg # 93450) |
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| Institute Fees: | ||
| Early registration (if received on or before May 19, 2008) | $1,825 | |
| Registration service fee (nonrefundable) | $35 | |
| Total fees enclosed: | $1,860 | |
| Regular registration* | $1,975 | |
| Registration service fee (nonrefundable) | $35 | |
| Total fees enclosed: | $2,010 | |
| *Deadline: June 16, 2008. After this date, onsite registration will be permitted on a space-available basis. No refunds will be granted after June 2, 2008. |
| Method of Payment: |
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Check in U.S. funds payable to University of Washington. Returned checks are subject to a $25 service fee. | |||
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Third-party payer -- separate document (purchase order or letter of authorization to bill) must accompany this form. | |||
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VISA | |
MasterCard | |
| Note: If paying by VISA or MasterCard, you may also register by phone at 206-897-8939 or 1-800-506-1325. | ||||
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___________________________________________________ Card number |
________________ Expiration date |
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____________________________________________________________________
Name as it appears on card |
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____________________________________________________________________
Credit card billing address |
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____________________________________________________________________
Signature |
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| Mail completed form to: | UW Extension Registration Services P.O. Box 45010 Seattle, WA 98145-0010 |
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| Or fax form to: | 206-685-9359 | |
| * For tax purposes, federal law requires the University to obtain your Social Security Number. | ||