*I confirm that
my paper has been accepted for presentation at IAPL 2002 and I do indeed wish to
participate. I am paying my IAPL 2002 Dues and Conference Registration
below. I will also complete the accompanying Program Participant Form,
IAPL Member Interests Form, and A-V Form (if necessary) once I have
submitted this form. [Enter your name to confirm.]
*Last Name
*First Names
*Position
*Department
*Institution
Office Address #1
Office Address #2
(Street)
Office Address #3
(City)
Office Address #4
(State/Province)
Office Address #5
(Postal/Zip Code)
Office Address #6
(Country)
Home Address #1
Home Address #2
(Street)
Home Address #3
(City)
Home Address #4
(State/Province)
Home Address #5
(Postal/Zip Code)
Home Address #6 (Country)
Office Telephone
Home Telephone
Fax
*E-Mail (make sure this is correct
since most IAPL communications are via e-mail.
*Re-enter your E-mail here (just to be
sure)
*Where do you want us to send
regular mail? Enter either "Send to Home Address" or "Send to Office
Address."
ANNUAL
DUES
(Dues cover one year beginning January 1st) US $ 45/ Regular
Members; US $25/ Retired Members; US $25/ Student Members
*Enter year(s) for which you are paying dues.
IF you have already paid IAPL 2002 dues, enter "IAPL 2002
dues already paid" [if this is not correct, your registration will not be
valid].
IF you are a New Member, enter "New Member."
IF you are renewing your membership, enter "Renewal."
*ENTER TOTAL AMOUNT OF DUES PAYMENT
IN US$
IAPL 2002
REGISTRATION
Early Registration Fees ($85 for
Regular Members; $40 Student and Retired Members) may be paid until March 15th,
2002. Persons on the IAPL 2002 Program must complete their registration process
by March 8th.
Fees paid after March 15th, 2002 or at the conference
will be at the rates of $105. for Regular Members ( Non-Members
$160); Student and Retired Members $55 (Student and Retired Non-Members $90)
*TOTAL AMOUNT OF REGISTRATION
PAYMENT IN US$
R OTTERDAM
IAPL 2002 END PARTY DINNER CELEBRATION AT THE
FORMER HOLLAND-AMERICA LINES
DEPARTURE BUILDING
Join us for the Saturday evening End-Party Celebration with
a genuine
Indonesian Dinner
,
an enticing Reception
, and VJ Entertainment
at the
Holland-America Lines Building
located in the center of Rotterdam,
on the banks of the Maas
River
and looking back at the Rotterdam Skyline.
This is the famous location from which many Europeans departed for the United
States.
Come join us
for this delightful event! Reserved Tickets must be picked up with registration packets at the Conference Registration
Desk on the Erasmus University Rotterdam campus. Please pay now if you
plan to join us. Any last minute reservations must be made prior to Wednesday
(June May 10th).
SEATING IS
LIMITED - Reserve Now
NAME(S) OF DINNER GUESTS [in addition to yourself]
Number of dinner tickets @ US $48 per person
*TOTAL AMOUNT OF DINNER TICKETS
REQUESTED -- US $
IAPL 2002 INTERMEDIALITIES
T-SHIRTS
Impress your friends with an IAPL 2002 T-Shirt (with the now familiar Dutch Intermedialities Design and the IAPL
Logo) and take home a charming and
useful souvenir of the conference! Please order now so that we
know how many to produce!
Number and Sizes of shirts required: @ $20 / T- shirt.
*TOTAL AMOUNT OF T-SHIRTS US $
PAYMENT SUMMARY
*1. IAPL DUES: US $
*2. IAPL 2002 REGISTRATION:
US $
*3. SATURDAY END-PARTY CELEBRATION DINNER: US $
*4. T-SHIRTS:
US $
*TOTAL OF ALL PAYMENTS:
US
$
*METHOD OF PAYMENT
IF you are mailing your payment (not recommended), include Check/Money Order (payable to "IAPL"
in
US
$) Enter Amount of Payment, Date of Check,
& Check Number
Credit Card Payment - type
of card:
VISA, M/C, AMEX
Amount authorized (US$)
Credit Card Number
Expiratio n
Date:
Authorizing Signature:
[enter your name as on your card]
Date of Credit Card
Authorization
You have now completed this form. Make sure that all your information
is correct. Once you press the SUBMIT botton, your form will be delivered
to the Membership Assistant. The CLEAR botton will erase all information
and you will have to start again.
