Introduction Background Committee Theme Schedule Presenters Exhibitions Hotel Transportation Resources Registration

On-Line Registration is now Closed:
Please pay for Registration at the Conference "ON-SITE"

This form may be used by delegates paying by credit card (preferred) or wire transfer. Delegates from the United States paying by check should complete the paper (pdf) version of the registration form and mail this with their payment. Rates for conference registration and meals are listed below. Advance registration is to be paid in US Dollars. Complete all of the required fields below, checking the appropriate boxes and then click "submit" to send this form. Delegates will receive and initial email confirming receipt of this form, with a later email confirming payment. If you have special needs or concerns, there is a box at the bottom of this form to include a note for the conference organizers.


(* indicates required field)

First Name:*
Family Name:*
Institution (if any):

Check One:
Student Identification Number (if applicable):

Street Address:*
City/State/Country/Postal Code:*

Email:*
Telephone:
Mobile:
Fax:

EARLY REGISTRATION DEADLINE: June 15, 2005 (NOW EXPIRED)

Regular Delegates: 130 US Dollars

Regular Polish and German Delegates: 65 US Dollars

Student Delegates: 50 US Dollars

LATE REGISTRATION DEADLINE: August 15, 2005 (NOW EXPIRED)

Regular Delegates: 170 US Dollars

Regular Polish and German Delegates: 100 US Dollars

Student Delegates: 80 US Dollars

ON-SITE REGISTRATION: After August 15, 2005

Regular Delegates: 200 Euros

Regular Polish and German Delegates: 120 Euros

Student Delegates: 100 Euros

MEALS AND BANQUET OPTIONS (SOLD OUT):
Box lunches will consist of a sandwich, small salad, fruit, dessert and beverage.

Box Lunch (meat or vegetarian) on Thursday September 8th: 6 US Dollars
 Box Lunch (meat or vegetarian) on Friday September 9th: 6 US Dollars
Banquet Dinner (meat or vegetarian) on Friday September 9th: 40 US Dollars

Check if you prefer vegetarian meals

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$ * TOTAL AMOUNT FOR REGISTRATION + MEALS (please add and enter number here)

Check here if you wish to reserve a table at the Open Portfolio Session on Friday September 9 in Poznañ, Poland

PAYMENT BY CREDIT CARD


Number
Expiration Date (month/year)
Name on the Card
Billing address for the card:

PAYMENTS BY WIRE TRANSFER:

Check here if you plan on paying via wire transfer

Please note that all bank charges for wire transfers are to be borne by the delegate. Minimum fee for AmSouth Bank is $35 plus any additional fees from originating bank(s). Be sure to convey this message to your bank. Delegates are responsible for sending a fax (1-865-974-3198) or email (blyons@utk.edu) confirming payment by wire transfer.

BANKING DETAILS:
AmSouth Bank
Swift Number: AMSBUS44
Account Name: Beauvais Lyons – Impact Conference
Account Number: 0054941083


Please use the space below to submit any notes you may have to the conference organizers: