CONFERENCE REGISTRATION FORM

The deadline for early registration is 16 December 1995.
Electronic registration by e-mail is acceptable, but fax
registration is preferred.

Carole Mann				Voice: +1 (407) 628-3602
Registration Systems Lab		Fax:   +1 (407) 628-3186
2060 Goldwater Court			E-mail: mann@cs.ucf.edu
Maitland, FL 32751 USA

Signature of e-mail registrants will be required at the conference;
refund requests must be submitted in writing by mail or fax.

Conference registration includes the proceedings, reception (ex-
cept for student registration), 3 continental breakfasts, 2 lunches,
and coffee breaks.

Scheme workshop registration includes continental breakfast on
Sunday, lunch, and coffee breaks.

Tutorial registration includes one coffee break.

Registration for any paid event includes the invited lecture.

For electronic registration, please send only the remainder of this form
to the above address.

-------------------------------------------
POPL 96 registration

Name:

Name tag should read:

Affiliation:

Address:

Voice phone:

Fax:

Electronic mail:

The list of attendees will be sent electronically, only to attendees.
May we include you on this list? (yes/no)

Dietary preference? (check at most one):
_ Vegetarian (may contain dairy, eggs)
_ Vegan (no animal products)
_ Kosher

Special needs or accommodations:


		Conference 	Workshop 	Tutorial
		Early Late			Early Late
				( Pick  at  most  one )
ACM and		 300  350 	   60 		50     65
(SIGACT or
SIGPLAN)
ACM or SIGACT	 325  375 	   70 		60     75
or SIGPLAN
Non-Member 	 350  425 	   80 		75     90
Full-Time 	 125  150 	   50 		35     50
Student
Total (Conference, workshop, tutorial):

Payment (check exactly one):
_ check (US$, payable to POPL '96)
_ Visa
_ MasterCard
_ American Express

Credit card number:

Expiration date:

Signature: