LCR 2000 May 25-27, 2000 Registration Form ----------------- Please print out this form and fax or mail with payment to: Sandhya Dwarkadas ATTN: LCR 2000 Registration Department of Computer Science University of Rochester Rochester, NY14627-0226 FAX: (716) 461-2018 Phone: (716) 275-5647 (Sorry, no phone registrations.) Email: lcr2k@cs.rochester.edu Please enter your name and contact information below (please type or print clearly). The registration deadline is Wednesday, May 3rd, 2000. Registrations received after May 3rd are subject to availability. IMPORTANT: HOTEL REGISTRATION DEADLINE FOR A GUARANTEED ROOM IS APRIL 24th, 2000. PERSONAL INFORMATION Last/Family name: First name: Middle initial: Badge name: (if different from first name) Organization: Mailing Address: City: State: Postal Code/Zip: Country: E-Mail: Telephone: Fax: SPECIAL NEEDS: Please check here if you require specific aids or services during your visit: Audio: Visual: Mobile: Vegetarian Meal: OTHER: NAME: Registration Fee: $175/- Full-time Student Fee (must show valid ID at workshop): $150/- Total Registration Fees: PAYMENT INFORMATION: Payment must be enclosed. Please make checks payable to "University of Rochester/Conference & Events Office". Registrations received without payment will not be accepted. Payment must be in US dollars. Registrants are encouraged to use a Personal Check or Company Check if possible. Please send payment to: Sandhya Dwarkadas ATTN: LCR 2000 Registration Department of Computer Science University of Rochester Rochester, NY14627-0226 FAX: (716) 273-4556 METHOD OF PAYMENT: Personal Check # ________________________________ Company Check #__________________________________ Visa __ MasterCard __ Credit Card Number: _____________________________ Expiration date: ________________________________ Card Holder Name: _______________________________ Signature: ______________________________________ (as it appears on the card)