Brigham Young University
June 9-11, 1999
Name _________________________________
Social Security # ________________________________
Company/Institution _____________________________________________________________________
Mailing address _________________________
City _________________________
State ____ ZIP ________
Business Phone ______________________________
Home Phone _______________________________
Spouse’s Name (if registering) _____________________________________________________________
Check all registration options:
[ ] 4a --- I will be attending the opening reception, Wednesday, June 9
[ ] 4b $25 Wednesday Symposium
[ ] 4c $52 Participant early registration (registrations received by May 17, 1999)
[ ] 4d $65 Participant late registration (registrations received after May 17, 1999)
[ ] 4e $55 Non-member early registration (registrations received by May 17, 1999)
[ ] 4f $70 Non-member late registration (registration received after May 17, 1999)
[ ] 4g $25 Early student registration (registrations received by May 17, 1999)
[ ] 4h $35 Late student registration (registration received after May 17, 1999)
[ ] 4i $30 Salt Lake City excursion, Thursday, June 10
[ ] 4j $28 Seven Peaks Water Park for children and teens, Thursday, June 10
River Park Steak BBQ, Thursday evening, June 10
$15 x ___ (No. attending) per adult,
$10 x ___ (No. attending) per child under 12
[ ] $15 Friday, June 11 luncheon
HOW TO REGISTER
By Mail: Mail in the completed registration form to the address below.
By Phone: Call (801) 378-2568 and pay with your VISA, MasterCard, or Discover card.
By Fax: Fax your registration to (801) 378-8165 and pay by VISA, MasterCard, or Discover card.
CHARGE MY
[ ] VISA [ ] MasterCard [ ] Discover
Card no. ________________________________ Expiration Date __________________
[ ] Check (payable in U.S. currency to Brigham Young University)
Total amount enclosed U.S. $ _________________________
Send completed registration form and payment to:
Brigham Young University
348 Harman Continuing Education Building
Provo, UT 84602-1532
Phone: (801) 378-2568
Fax (801) 378-8165