Registration Form for Random-Approx '01 Conference EARLY REGISTRATION DEADLINE: July 31, 2001 Family Name: ____________________________ First Name: ____________________________ Organization: ____________________________ Department: ____________________________ Organization Address: ____________________________ ____________________________ City: ____________________________ State: ____________________________ Zip Code: ____________________________ Country: ____________________________ Telephone: ____________________________ Fax: ____________________________ Email Address: ____________________________ Vegetarian (Y/N)?: _________________________ PAYMENT INFORMATION We are unable to accept International Postal Money Orders. Please enclose check in U.S. dollars or International Money Order payable to: Random Conference and send it to: Jose Rolim C.U.I. 24 rue General Dufour 1204 Geneva Switzerland We accept payment by mail or fax using either Visa, Mastercard, or American Express. Please complete the following information when using a credit card: Type of credit card: ____________________________ Credit card number: ____________________________ Expiration date: ____________________________ Print name as shown on credit card: ____________________________ Signature: ____________________________ REGISTRATION FEES (includes entrance to all sessions, a copy of the proceedings, the banquet, coffee breaks and other conference costs): $200.00 Early registration received before July 31, 2001 $________________ $170.00 Student registration received before July 31, 2001 $________________ $280.00 Regular registration received after July 31, 2001 $________________ $250.00 Student registration received after July 31, 2001 $________________ Please fax or mail to: Jose Rolim Random-conference 24 rue General Dufour 1204 Geneva Switzerland email: rolim@cui.unige.ch fax: + 41 22 7057780