Foresight 2003 Conference
and Tutorial
Registration Form

 PLEASE PRINT
and fax or mail this form to:
Foresight Institute, Box 61058
Palo Alto CA 94306 USA
Tel: 650-917-1122 · Fax: 650-917-1123
Name: ________________________________________
Address: ________________________________________
 ________________________________________
City, State: ________________________________________
Zip/Postal Code, Country: _________________________________
Phone: ________________________________________
Fax: ________________________________________
Email: ________________________________________
Position (professor, director, programmer, etc.):
 ________________________________________
Organizational affiliation (for your badge):
 ________________________________________
How did you hear about this conference:
· email · web · publication: 
· other: 
 ________________________________________
Please make checks payable to the Foresight Institute.
Checks and bank drafts must be in U.S. dollars drawn on a U.S. Bank.
VISA or MasterCard Number: _______________________________
Exp. Date (Month/Year): ____________________________
Signature: ________________________________________
Print name as it appears on credit card:
________________________________________

 ___ Yes, include my contact information: name, badge affiliation, and email on an attendee list.
 ___ No, do not include my contact information on an attendee list.
Conference—Lunches included (Oct. 10-12)
Academic, Nonprofit, Govt., Sr. Assoc.   $595
Corporate, Individual   $725
Full-time Student*   $325
One day · Fri · Sat · Sun   $225
Conference—NO LUNCHES** (Oct. 10-12)
Academic, Nonprofit, Govt., Sr. Assoc.   $465
Corporate, Individual   $590
Full-time Student*   $195
Tutorial Fees include lunch (Oct. 9)   $595
Optional Item:
Feynman Prize Banquet (Oct. 11) 6:30 PM   $75

* Full-time students must fax a copy of a current university student ID with the registration form or Academic Fee will be charged.
** No lunch option omits lunch on Friday and Saturday.
Conference:   $ _____
Tutorial:   $ _____
Feynman Prize Banquet:   $ _____
TOTAL:   $ _____

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Last updated 26 November 2003. The URL of this document is: http://www.foresight.org/Conferences/MNT11/RegForm.html