Registration Form

CCSC:Southeastern Conference on November 7-8, 2003

Early Registration (by October 3, 2003)

Late/On-Site Registration

Cost per person

Total Paid

Cost per person

Total Paid

Registration

$130

$140

Extra Proceedings

$10

$10

Extra Friday Banquet Ticket

$25/ticket

$25/ticket

Extra Saturday Lunch Ticket

$10/ticket

$10/ticket

Total (sum of amounts paid):

Registration includes the following: access to all vendors and sessions, one ticket for Friday banquet & Saturday lunch, one copy of the proceedings, copies of the CCSC Journal for the 2003-2004 academic year, and voting privileges for the same year.

 I will be attending the pre-conference workshop by Dan McCracken: "Human-Computer Interaction in the Classroom",

Member ID:

Change of address (circle one): yes / no

Type of address (circle one): home / institution

Name:

Phone:

Position:

Fax:

Department:

Email:

Institution:

I would like to receive mailings from the following regions (circle at most eight):

CP    ES    MW    NE    NW    RM    SC    SE

Voting Region (circle one):

CP    ES    MW    NE    NW    RM    SC    SE

Address:

City, State, Zip:

Please circle if you are a FIRST TIME ATTENDEE of the CCSC:Southeastern Conference.

Please circle if you wish to have VEGETARIAN meals.

Please circle if you DO NOT wish your name included in a published participant list.

Please circle if you DO NOT want to be added the CCSC listserver(s).

Please make checks payable to:

CCSC (the Consortium for Computing in Small Colleges).

CCSC does not accept credit cards.

(Note: The Consortium will assess a charge of $25 for each check returned to it by the issuing bank)

MAIL FORM TO:

Kris D. Powers

Department of Mathematical Sciences

Berry College

P. O. Box 5014

Mount Berry, GA   30149-5036

Regions are: Central Plains, Eastern, Midwest, Northeast, Northwest, Rocky Mountain, South Central, Southeast.