5th INTERNATIONAL CONFERENCE ON CLIFFORD ALGEBRAS AND THEIR 
	              APPLICATIONS IN MATHEMATICAL PHYSICS 
	        Ixtapa-Zihuatanejo, MEXICO, June 27-July 4, 1999

	                       Registration Form

	This form is for new registrations only. If you have already 
	registered and wish to make changes, contact Senora Irma Aragon at 
	keller@servidor.unam.mx. Otherwise, print this form out, fill it out, 
        then mail it, fax it, or email it to the address below. Complete 
	instructions are at: http://math.tntech.edu/rafal/mexico/mexico.html.

	First and Last Name: ______________________________________________

	Organization: ____________________________ Phone: _________________

	Address: __________________________________________________________

	E-Mail: _____________________________ Fax Number: _________________

	Arrival Date: __________________ Departure Date: __________________
                                                     
	Registration Fee ($425 before June 21, $500 after):    ________ USD
        (4 nights, 3 days, 3 meals per day, all taxes)

	Seven Nights ($671 before June 21, $746 after):        ________ USD
        (Registration Fee, 7 days, 3 meals per day, all taxes)

	Extra payment (explain): __________________________________________

	____________________________________________________ __________ USD

	Extra payment in support of graduate students:       __________ USD

	                                TOTAL PAYMENT:       __________ USD
	Method of Payment:
	(a) Check (type of check and number): _____________________________
            (Check payable to: "5th Conference, Account Number: 8400067")

	(b) Wire transfer (date): ___________________________
    	    Routing Procedure: ABA Number - Memphis 084000026 
            First Tennessee Bank Cookeville 064101903 
            Tennessee Technological University Account Number 8400067
            (Confirm wire transfer with Tim Guffey at TGuffey@tntech.edu.) 

	(c) Credit Card Used (check one): VISA ____ Master Card ____
       
	    Credit Card Number: ______________________ Expr. Date ________

            Name on the card (please print): ______________________________
	    (If you prefer not to put credit card information on this form,
            call Mamie Goulet, Departmental Secretary, and give her this
            information. Phone: USA (931) 372-3441)

    	Registration Confirmation and Receipt:
	(a) Please send both via Mail ___ or E-mail ___ (Confirmation only) 
	(b) No need to send, will pick them up in Ixtapa upon arrival ___  

	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: ____________________