Please fill out this form and submit it by pressing the <submit>-button below.

Name:

Organization:

Address:

Address-additional:

City, State:

Zip Code:

Country:

Phone:

Fax:

E-mail:

Companion's name:

Paper Title:

Brief Description:

Registration Fee: $295 by September 8^th, $325 thereafter

Companion fee: $50

This site is not secure. Your credit card number will be sent by unencrypted e-mail if you enter it here. If you wish, leave this part blank and call in your credit card at (203) 432-3090. (Ask for Karen, Mary Anne, or Jeff Ashenfelter.)

Payment method:

Visa Master Card Check/Money Order Phone-In

Credit Card No.:

Exp. Date: Month: Year:

Name on Card:

Hotel Reservations: Make directly with the OMNI Hotel at (800) 843-6664 prior to September 8^th, ask for SNEAP rate ($119/night) A Fax-able registration form is available: OmniReservationForm.pdf.

Banquet Choices:

Beef Chicken Fish Special/Other

Special needs or suggestions: