Foresight '97 Conference
and Tutorial
Registration Form

PLEASE PRINT
and fax or mail this form to:
Foresight Institute, Box 61058
Palo Alto CA 94306 USA
Tel: 415-917-1122 Fax: 415-917-1123

Name: ________________________________ Work Phone (optional): ________________
Address: ______________________________
______________________________________
Home Phone (optional): ________________
City, State: ____________________________ Fax: __________________________
Zip/Postal Code, Country: ________________ Email: _________________________________
Position (professor, director, programmer, etc.):
_____________________________________
Organizational affiliation (for your badge):
_______________________________________
How did you hear about this conference:

Amount enclosed (check one):
Tutorial Only:___ $395 by Aug. 31___ $495 after Sept. 1
Conference (Regular) Only:___ $495 by Aug. 31___ $695 after Sept. 1
Conference (Academic, etc.) Only:___ $395 by Aug. 31___ $495 after Sept. 1
Conference (Student) Only:___ $150 by Aug. 31___ $195 after Sept. 1
Conference (1 Day: ___) Only:___ $195 by Aug. 31___ $295 after Sept. 1
Conf. (Regular) + Tut.:___ $890 by Aug. 31___ $1190 after Sept. 1
Conf. (Academic, etc.) + Tut.:___ $790 by Aug. 31___ $990 after Sept. 1
Conf. (Student) + Tut.:___ $545 by Aug. 31___ $690 after Sept. 1
Conf. (1 Day: ___) + Tut.:___ $590 by Aug. 31___ $790 after Sept. 1
Please make checks payable to the Foresight Institute. Checks and bank drafts must be in U.S. dollars drawn on a U.S. Bank.

VISA or MasterCard Number:____________________________

Exp. Date:___________ Month/Year Signature ________________________________

Senior Associates of Foresight Institute or IMM may register at the academic rate, regardless of their employment status.

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The URL of this document is: http://www.foresight.org/Conferences/MNT05/RegForm.html