Student 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

$25

$25

Proceedings

$10

$10

Friday Banquet Ticket

$25/ticket

$25/ticket

Saturday Lunch Ticket

$10/ticket

$10/ticket

Total (sum of amounts paid):

Registration includes the following: access to all vendors and sessions.
(Meals and proceedings are not included, and must be paid for separately.)

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

Type (please circle one):

Presenter

Programming Contest Participant

Web Authoring Contest Participant

Volunteer

Regular Attendee

Other:               

Name:

Email:

Faculty Advisor:

Institution:

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

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