Print this page out, fill it out and fax/mail it accordingly. San Diego Registration Form I will attend: O Thursday, December 6, 2001 O Friday, December 7, 2001 O Saturday, December 8, 2001 O All three days of the conference NAME _________________________________________________________ ORGANIZATION _______________________________________________ ADDRESS ______________________________________________________ CITY ________________________ STATE _____________ ZIP __________ DAYTIME PHONE NO. ___________________________________________ FAX NUMBER _________________________________________________ ENCLOSE FULL TUITION A 10% discount is available for groups of 3 or more registered together. A 15% discount is available for full time students (must include documentation of full time student status). Only one kind of discount can be applied, discounts can not be combined. REGISTRATION POSTMARKED BY: AUGUST 10, 2001 THURSDAY ONLY FRIDAY ONLY SATURDAY ONLY ALL THREE DAYS $120.00 $120.00 $120.00 $325.00 REGISTRATION POSTMARKED BY: SEMPTEMBER 25, 2001 THURSDAY ONLY FRIDAY ONLY SATURDAY ONLY ALL THREE DAYS $145.00 $145.00 $145.00 $375.00 REGISTRATION POSTMARKED BY: OCTOBER 25, 2001 THURSDAY ONLY FRIDAY ONLY SATURDAY ONLY ALL THREE DAYS $155.00 $155.00 $155.00 $395.00 METHOD OF PAYMENT O A check made payable to FACES O Purchase order is attached O Charge my O Visa O Mastercard Register by Mail: FACES, c/o Richard Fields, Ph.D. 5010 243rd Ave. NE Redmond, WA 98053

NAME OF CARDHOLDER (Please Print Clearly) ___________________________________________ CREDIT CARD # (Please Print Clearly)_______________________________ EXP. DATE ____/____ SIGNATURE ______________________________________________________________ Register by Phone: (877) 63-FACES (425) 868-7253 Register by Fax: (425) 868-5644 ---------------------------------------------------------------------------------------------------- Return to Previous Page