International Python Conference IV Registration Form

Tutorials: Mon, June 3 1996
Conference: Tue, June 4 - Thu, June 6 1996

NOTE!! Regardless of early registration, the conference facility requires advance ID (social security number, or some international id like passport) and drivers license to produce clearance for you! Extra-nationals will require even more advance notice! There is likely to be a several hour delay before admittance if you just show up at the door!

Please complete and include this form with your check (U.S. dollars drawn on a U.S. bank), payable to the Corporation for National Research Initiatives. Mail to: 

	Corporation for National Research Initiatives
	ATTN: Accounting Department - IPC-IV
	1895 Preston White Drive, Suite 100
	Reston, VA 22091-5434

Please Type or Print

Name (Dr|Mr|Ms) _____________________________________________________

Organization ________________________________________________________

Email _______________________ Phone ______________ FAX ______________

Address _____________________________________________________________

Address _____________________________________________________________

City ___________________________ State ______ Postal Code ___________

Student? ___  University _______________________ ID Number __________

Home Address ________________________________________________________

Home City ________________________ State ____ Postal Code ___________

SSN _____________________  ID Type ______________  ID # _____________

For instance, if the registrant is using a drivers license for ID, LLNL
wants ID number &  state.  If a passport, then it's number.  Whatever
type of ID is being used to obtain a badge, identify that form of ID.

PSA membership      Member __,   Joining now __,  or  Not a Member __


Early: $50 (before May 17, '96) or Regular: $75   _____

Tutorials: $100                                 + _____

Joining PSA (also complete PSA application)     + _____ 
                                                  _____
                                                 |     |
                                     Subtotal:   |_____|

Deduct 50% student discount:                    - _____

Deduct $10 PSA member discount:                 - _____
                                                  _____
                                                 |     |
                                        TOTAL:   |_____|

Notes