DISCOUNT ADVANCE REGISTRATION FORM American Society of Civil Engineers 5th International Symposium on Cold Region Development "ISCORD '97" Anchorage, AK May 5 - 8, 1997 Please Print or Type Name: ________________________________________ Nickname: ________________________________________ Title: ___________________________________________________ P.E.: ___yes ___no Ph.D.: ___yes ___no Company: ______________________________________________________________________________ Mailing Address: ______________________________________________________________________ City/State/Zip: _______________________________________________________________________ Country: ______________________________________________ e-mail addess: ________________________________________ Telephone: ___________________ FAX: ___________________ Spouse/Guest (if registering): ____________________________ Type of Business (check appropriate category) Government Private Educational Military Federal __ Engineering Firm __ Professor __ Corps of Engrs. __ State __ Consultant __ Student __ Other __ Local __ Industry __ Member (check appropriate organization) ASCE __ Conference Cooperating Organization __ ASCE Membership # ________________________________________________ Name of Cooperating Organization: ____________________________________ How many ASCE Specialty Conferences do you attend per year? (check appropriate category) 1 __ 2-3 __ 4 or more __ ___ Please check here if you will require accommodations due to a disability or impairment and include a description of your needs. Location while attending: __ Headquarters hotel __ Home __ Other hotel Hotel name: _____________________________________________________ CALL 1-800-548-ASCE FOR CONVENIENT CREDIT CARD REGISTRATION PAYMENT. Please complete if paying by credit card: AE VISA MC DINERS DISCOVER (circle) Card Number: _______________________________________________________________________ Exp. Date: ____________________ Signature: _________________________________________________________ Government P.O. #___________________________________ Make check payable to: ASCE CR CONFERENCE. Checks must be issued in U.S. Dollars, drawn on U.S. Banks. To quality for early pre-registration discount, postmark form before March 28. Registrations will not be processed without payment or purchase order. Mail to: ASCE, Conferences and Expositions, P.O. Box 832, Somerset, NJ 08875-0832, USA. Phone: 1-800-548-ASCE or (703) 295-6300; FAX: (703) 295-6333. Cancellations must be made in writing to the ASCE office by April 18, 1997, in order to receive refund. A $50 processing fee will be deducted from the registration fee. Additional event tickets will be refunded in full if cancelled in writing by April 18, 1997. Send to above address or fax to (703) 295-6333. NO REFUNDS WILL BE GIVEN FOR CANCELLATIONS RECEIVED AFTER APRIL 18, 1997. TO REGISTER FAST CALL 1-800-548-ASCE REGISTRATION FEES By 3/28 On-Site Amount Indicate items selected Full Conference Registration (Includes session attendance, pro- ceedings, Reception, Luncheon, and Banquet.) Members of ASCE, IACRDS, and $445 $545 _______ Cooperating Organizations Nonmembers $620* $720* _______ Daily Registration (Includes session attendance only for day of registration.) Circle day: Mon Tues Wed Thurs Members of ASCE, IACRDS, and $150 $200 _______ Cooperating Organizations Nonmembers $225 $275 _______ Full-Time Students $50 $50 _______ (Includes session attendance only; proof of full-time student status required.) Banquet Function Tickets No. Tkts Price Icebreaker Reception (Mon) _____ $25 _______ (Included with full reg.) Tuesday Luncheon (Tues) _____ $23 _______ (included with full reg.) Banquet (Wed) _____ $50 _______ (Included with full reg.) Spouse/Guest Registration _____ N/C _______ (No charge; reservations required. Includes Mon. breakfast.) TOTAL $_______ Note: Please register for all tours directly with Alaska Vacations International, Inc. (see tour registration form). *Of the nonmember full registration fee, $75 may be applied toward a new membership application fee. For more information, call 1-800-548-2723 (ASCE) or 703-295-6300.