Registration
Registration fee includes morning and afternoon coffees/snacks and lunch. Please submit registration information so we have it in electronic form. For payment, please print form and fax to 847-467-2269 with credit card information or mail with check made payable to Northwestern University to: Heather Rice 2220 N Campus Drive Evanston, IL 60208. (Credit card information is not included in the electronic submit.) If the electronic submit does not work, please fax, mail, or e-mail (riceh@northwestern.edu) your registration.
First Name
Last Name
Street Address
City, State and Zip
Affiliation:
E-mail:
Interests:
Registering for (meeting, short course, etc.):
Total payment due (see below):
Credit card information
Name on Card:
Type of Card: (Visa, Mastercard, and American Express accepted.)
Card Number:
Expiration:
Check number:
CUFS number (northwestern only)
Product
Qty
Price
Early Student Registration
$ 10.00
Early General Registration
$ 25.00
Parking pass needed
$ 0
Short course 1 registration
$ 300.00
Short course 1 student registration
$100.00
Short course 2 registration
$ 300.00
Short course 2 student registration
$100.00
After June 1st add
$ 5.00
Total: