FEE-BASED '97
INFORMATION DELIVERY IN THE 21st CENTURY:
SURVIVING THE MILLENNIUM

Conference Registration Form

Please print out, complete and send in with payment.

Name___________________________________________________________________
Title____________________________________________________________________
Address _________________________________________________________________
________________________________________________________________________
Telephone_______________________ E-mail___________________________________
Name and affiliation, if any, for badge_________________________________________
________________________________________________________________________

Amount enclosed (see fee table) __________. Please make check payable to UC Regents.

I plan to attend the following events:

I will require special services:



Please return this form and your registration fee to:

Laura Chipps
Corporate Programs Coordinator
UCSD Geisel Library 0175V
9500 Gilman Drive
La Jolla, CA 92093
(619) 534-0747