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
email@example.com (not recommended if paying by check or credit
Name: _____________________________ Gender: F M
____________________________ State or province: __________
Postal code: _________
Telephone: Country code _____ tel.
_______________ fax. ______________
E-mail address: __________________________________
|fee - USD|
registration: before 15 April
registration: April 16 to June 14
country* participants by June 14
from transitional countries** by June 14
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
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
University of Washington
Seattle, WA 98195 USA
+1 (206) 616-5775 (fax)