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Print this page out, fill it out and fax/mail it accordingly. Washington D.C. Registration Form I will attend: O Thursday, April 25, 2002 O Friday, April 26, 2002 O Saturday, April 27, 2002 O All 3 days of the conference NAME _________________________________________________________ ORGANIZATION _______________________________________________ ADDRESS ______________________________________________________ CITY ________________________ STATE _____________ ZIP __________ DAYTIME PHONE NO. ___________________________________________ FAX NUMBER _________________________________________________ EMAIL ADDRESS*:_________________________________________________ ENCLOSE FULL TUITION A 10% discount is available for groups of 3 or more registered at the same time. 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: January 20, 2002 THURSDAY FRIDAY SATURDAY 3 DAYS $110.00 $110.00 $110.00 $299.00 Registration Postmarked By: February 20, 2002 THURSDAY FRIDAY SATURDAY 3 DAYS $125.00 $125.00 $125.00 $335.00 Registration Postmarked By: MARCH 20, 2002 THURSDAY FRIDAY SATURDAY 3 DAYS $140.00 $140.00 $140.00 $365.00 Registration Postmarked After: MARCH 20, 2002 THURSDAY FRIDAY SATURDAY 3 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