Conference Registration Form s3

Conference Registration Form s3

<p> CONFERENCE/WORKSHOP REGISTRATION FORM </p><p>MIXTURE MODELS IN LATENT VARIABLE RESEARCH Conference: May 18—19, 2006 Workshops: May 17 & May 20, 2006 University of Maryland, College Park, Maryland</p><p>Participant’s Name: ______Participant’s Title: ______Agency/Organization/School: ______Street Address: ______City: ______State: ______Zip: ______Phone: ______Fax: ______E-mail: ______</p><p>Registration Fees (Check all that apply): Pre-session Mplus workshop ($75) – May 17 Conference attendance ($145 for professionals and $95 for students) – May 18 & 19 Post-session WINMIRA workshop ($75) – May 20</p><p>Choose your form of payment for the registration fees. 1) Check Number: ______2) Purchase Order Number: ______3) Credit Card Type (Visa, MasterCard, Discover only): ______Number: ______Expiration Date: ______4) Cardholder (print name on credit card): ______</p><p>Registration Policies:  A check or company purchase order made payable to the University of Maryland [tax ID number: 52-6002-033] or credit authorization must accompany your registration for it to be considered complete.</p><p> Your registration fee covers the cost of all conference materials, refreshments at breaks, and two continental breakfasts. Participants are responsible for all other meals, lodging and parking ($8/day).</p><p> Registration is on a first-come, first-serve basis. Early registration is advised, as the maximum enrollment limits cannot be exceeded. </p><p> A full time student (verified by signature below) may register for the two-day conference at the reduced rate of $95. 1. Dept. Head Signature: ______2. Print Name of Department Head: ______3. Institution & Department: ______</p><p>Cancellation Policy:  Should you find it necessary to cancel your registration, your registration fee less $25.00 will be refunded if notice of cancellation is received prior to the date of the event(s) for which you were registered. Contact:  Please direct any questions about registration, conferences, workshops, or lodging and facilities to: Ricardo Morales Phone: (301) 405-3629 1230 Benjamin Building FAX: (301) 314-9245 University of Maryland E-mail: [email protected] College Park, Maryland 20742</p>

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