CCSC Attendee Registration Form
Eastern 2004 Conference on Oct. 15 - 16, 2004

Registration includes the following: admission to all sessions, proceedings, banquet, and luncheon, one copy of the proceedings, copies of the CCSC Journal for the 2004-2005 academic year, and CCSC voting privileges for the same year.
 

Friday Banquet Preference: (check one)

Vegetarian Yes             No

 

Member ID: _______________________________	Change of address:  yes / no Type of address:     home / institution
Name: ____________________________________________	Phone: _____________________
Position: __________________________________________	Fax:     _____________________
Department: _______________________________________	Email:  ___________________________________________
Institution: _________________________________________	I would like to receive mailings from the following regions: (circle at most eight):  CP E MW NE NW RM SC SE Voting Region (please circle one)   CP E MW NE NW RM SC SE
Address: __________________________________________ __________________________________________________ __________________________________________________
City, State Zip : ____________________________________

        Please circle if you do not wish your name included in a published participant list.
 

        Please circle if you do not want to be added the CCSC listserver(s).
 

Please write checks or money orders payable to the CCSC.  CCSC does not accept credit cards.

The Consortium will assess a charge of $25 for each check returned.

Please mail this form to the following:

Richard Brown Department of Computer Science Loyola College in Maryland 4501 North Charles Street Baltimore, MD 21210-2699 Phone: 410-617-2095 Fax: 410-617-2157 E-Mail: rbrown@loyola.edu

For more information, please see: http://justice.loyola.edu/ccsce04 and/or http://www.ccsc.org/

Regions are: Central Plains, Eastern, Midwest, Northeast, Northwest, Rocky Mountain, South Central, Southeast.