SOD Symposium-Registration Form

FILL OUT THE FORM BELOW. PRINT IT OUT AND FAX TO: (510) 643-3490 or MAIL TO: Integrated Hardwood Range Management Program, Attn: Joni Rippee, 145 Mulford Hall, University of California, Berkeley, CA 94720-3114.

Name:
Organization:
Street Address:
City:		State:		Zip Code:		Country:
Day Phone:				FAX:
Email:
Arrival Date:	(MM/DD/YY)		Departure Date:		(MM/DD/YY)

SPECIAL DIETARY NEEDS: Choose one.

NONE

VEGETARIAN

OTHER:

FEE SCHEDULE

FEE

NO.

AMOUNT

Pre-Conference Field Trip to Big Sur, Sunday December 15, 1:00 to 5:00 pm (There is a limit of 150 participants)

$20.00

Early Registration: postmarked by 11/20/02 (Includes 2 breakfasts, 1 lunch, 2 receptions and all breaks)

$250.00

Late Registration: postmarked after 11/20/02

$300.00

Spouse Registration (Includes 1 lunch and 2 receptions)

$100.00

TOTAL FEE PAID

PAYMENT OPTIONS: Choose one.

	CHECK ( Payable to UC Regents. Please mail with form.)
	CREDIT CARD (Your card will be charged upon receipt.)
	Please check one:		VISA	MASTERCARD
	Credit Card Number:
	Three-Digit Signature Panel Code:	The three-digit CVV2 (VISA) and CVC2 (MasterCard) Code is located on the back of your credit card next to your signature. This code is the LAST three digits of the number listed.
	Expiration Date:	(MM/YYYY)
	I understand that I am registering for the Symposium and that my credit card will be charged the full fee if I do not cancel in writing by DECEMBER 4, 2002.
	Signature:
After completing form, print it out, and mail or fax. See instructions above.

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