Second International Conference on Climate Impacts Assessment (SICCIA)


Instructions: Either print this form, fill it out, and mail or fax it; or edit the form with an html editor and e-mail it to (not recommended if paying by check or credit card).

Name: _____________________________   Gender:   F  M  

Address:  _____________________________________


City:    ____________________________   State or province: __________

Postal code:   _________    Country:  _________

Telephone:  Country code  _____  tel.  _______________  fax. ______________

E-mail address: __________________________________

 fee - USD
Early registration: before 15 April
160 []
Regular registration: April 16 to June 14
210 []
Developing country* participants by June 14
no charge []
Participants from transitional countries** by June 14
60 []

* see
** Belarus, Bulgaria, China, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Russian Federation, Ukraine. 
To discuss reduced registration fee, please contact Philip Mote.

Please check one:
[]  A check for the registration fee in US Dollars is enclosed.

[]  Please bill my credit card: 
       Visa/Mastercard   _______-_______-_______-_______ exp  ___  20___

        Name as it appears on credit card: ____________________________

[]  Please contact me to arrange a wire transfer.  The processing fee is an additional $25.

Hotel reservation
Please check one:
[]  I have made hotel reservations already.
[]  I will make hotel reservations by 10 May (conference participants are required to stay at Eibsee Hotel).
[]  I would like to share a room to reduce costs; please assign me a roommate.

[] I require a letter of support to obtain a visa
Attach a paragraph describing your duties in your organization and how you would benefit from participating in SICCIA. Also, please send the address and/or fax to which the letter of support must be sent.

send completed registration form to

attn. Kathryn Vinson
Climate Impacts Group
Box 354235
University of Washington
Seattle, WA 98195 USA

+1 (206) 616-5775 (fax)