Second International Conference on Climate Impacts Assessment (SICCIA)


Registration

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 kvinson@u.washington.edu (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 http://unfccc.int/text/program/sd/ldc/countries.html
** Belarus, Bulgaria, China, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Russian Federation, Ukraine. 
To discuss reduced registration fee, please contact Philip Mote.

Payment
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

SICCIA
attn. Kathryn Vinson
Climate Impacts Group
Box 354235
University of Washington
Seattle, WA 98195 USA
kvinson@u.washington.edu


+1 (206) 616-5775 (fax)