The 6th INTERNATIONAL CONFERENCE ON CLIFFORD ALGEBRAS, May 20-25, 2002 and Lecture Series on Clifford Algebras, May 18-19, 2002 REGISTRATION AND FEES PAYMENT FORM Instructions: Please print this form out, fill it out, then mail it, fax it. For complete instructions go to: http://math.tntech.edu/rafal/cookeville/fees.html. First and Last Name: ______________________________________________ Organization: ____________________________ Phone: _________________ Address: __________________________________________________________ E-Mail: _____________________________ Fax Number: _________________ Arrival Date: __________________ Departure Date: __________________ Please check all that apply: 1. I am a (graduate) student _____ or a post-doc _____. 2. I am a plenary speaker, lecturer, or session organizer _____. 3. Please reserve ____ single room or ____ double room in dormitory. If you will be staying in a hotel, please make your own reservation. Visit http://math.tntech.edu/rafal/cookeville/cookeville.html for more information. 4. Conference Registration Fee: Regular Fee: $180 before 3/15/02 or $210 after 3/15/02: _____ USD Reduced Fee: $80 before 3/15/02 or $110 after 3/15/02: _____ USD I am (please check one): student ____ , post-doc ____ , unemployed ____ , from developing country ____ , publisher attending as exhibitor ____ , other ________. NOTE: To request more support, please complete point 15 below. 5. $10 fee reduction for those staying in a dormitory: ______ USD 6. Additional Fee for Exhibitors: Five days (May 20 - 25): $300 before 3/15/02 or $330 after 3/15/02, or, No. of days ______ from ______ to _______ at $100/day ______ USD 7. Registration Fee for the Lecture Series: $25 before 3/15/02 or $35 after 3/15/02: ______ USD 8. Dormitory: No. of nights ____ times $11/person in single room or $ 9/person in double room ______ USD 9. Shuttle tickets: Nashville Airport -> Cookeville: Number ____ at $15/ea. ______ USD Arrival if known: Date _______ Time _______ Flight _______ Cookeville -> Nashville Airport: Number ____ at $15/ea. ______ USD Departure if known: Date _______ Time _______ Flight _____ 10. Ticket(s) to Fitness Center: Number _____ at $10/ea. ______ USD 11. Extra banquet ticket(s): Number _____ at $20/ea. ______ USD 12. Wednesday evening concert: Number _____ at $70/ea.(*) ______ USD TOTAL PAYMENT: __________ USD (*) Exact amoung will be posted as soon as it is known. 13. Method of Payment: (a) Check (type of check and number): ______________________________ Make check payable to: "6th Conference, Account Number: 8400067" Only checks payable in U.S. dollars will be accepted. (b) Wire transfer (date): ___________________________ Routing Procedure: ABA Number - Memphis 084000026 First Tennessee Bank in Cookeville 064101903 located at 345 S. Jefferson Ave. Cookeville, TN 38501 Tennessee Technological University Account Number 8400067 Confirm transfer with mcrabtree@tntech.edu and sbrown@tntech.edu. (c) Credit Card: VISA _____ Master Card _____ Discover _____ Credit Card Number: ______________________ Expr. Date _________ Name on the card (please print): ______________________________ If you prefer not to put credit card information on this form, call Vickie Mayberry, Conference Secretary, and give her this information. Phone: USA (931) 372-3442, or fax it to Math. Dept. (931) 372-6353. 14. Registration Confirmation and Receipt: (a) Please send both via Mail ___ or E-mail ___ (Confirmation only). (b) No need to send, will pick it up in Cookeville upon arrival ___. If you do not request support from the Organizers, please stope here, sign below, and fax in Pages 1 and 2 of this form to (931) 372-6353. Otherwise, please complete point 15 below. _____________________ Signature Rafal Ablamowicz, Department of Mathematics, Box 5054, Tennessee Technological University, Cookeville, Tennessee 38505, USA rablamowicz@tntech.edu, (931) 372-3441, FAX: (931) 372-6353. Date Received at TTU: ____________________ ******* Cut here if you don't request support from organizers ******* REQUEST FOR SUPPORT FROM ORGANIZERS If you want to request support from Organizers, please complete point 15, sign below, and fax Pages 1, 2, and 3 to (931) 372-6353. Preference in determining support will be given to those presenting a paper in one of the thematic areas covered by the Conference. NOTE: Students are asked to submit a letter (can be via e-mail to rablamowicz@tntech.edu) from their advisor in support of this application. Advisors are asked to comment on the student's work, its relation, if any, to the field of Clifford algebras, and on potential benefits to the student from attending the Conference. 15. I request financial assistance from the organizers in the following form or amount: (a) Registration fee reduced to _____ Reason: ______________________ ____________________________________________________________________ ____________________________________________________________________ (b) Registration fee waived completely _____ Reason: _______________ ____________________________________________________________________ ____________________________________________________________________ (c) Free transportation between Nashville airport and Cookeville ___ Reason: ____________________________________________________________ ____________________________________________________________________ (d) Free dormitory housing _____ Reason: _________________________ ____________________________________________________________________ ____________________________________________________________________ (e) Please check one: Partial coverage of the hotel cost _____ or free space in a shared hotel room _____. Reason: ____________________________________________________________ ____________________________________________________________________ (f) Cash amount of: _______ USD [may require a special U.S. visa] (g) Other __________________________________________________________ Explanation: _______________________________________________________ ____________________________________________________________________ ____________________________________________________________________ _____________________ Signature Rafal Ablamowicz, Department of Mathematics, Box 5054, Tennessee Technological University, Cookeville, Tennessee 38505, USA rablamowicz@tntech.edu, (931) 372-3441, FAX: (931) 372-6353. Date Received at TTU: ____________________