Conference on Cost-Sharing Registration Form

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Conference on Cost-Sharing Registration Form

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FDP/Stanford/University of California System
Conference on Cost-Sharing
Wednesday, December 1, 1999
Nob Hill Masonic Center, 1111 California Street, San Francisco, CA

REGISTRATION FORM - DEADLINE FOR REGISTRATION and PAYMENT IS
Friday, November 12, 1999

Last Name:       _____________________First Name: _____________________
Title:               _____________________________________________________
Department:     _____________________________________________________
Organization:    _____________________________________________________
Street Address: _____________________________________________________
City:                   ________________________   State:   _____Zip: ____________
Phone:    (______)_________________ Fax: _______________________
Email:                _____________________________________________________

Everyone: Check all that apply:

ð I am part of an FDP Member/Affiliate Member Institution
ð I am not part of an FDP Member/Affiliate Institution

Check one that applies:

ð I am the Federal Agency's (one) official Administrative Representative (the voting member)
ð I am the Federal Agency (one) official Program Representative (the voting member)

ð   I am the FDP University or Research Institution's (one) official Administrative Rep(the voting
            member)
ð   I am the FDP University orResearch Institution (one) official Faculty Rep (voting member)

ð I am part of my group's delegation - I am not an official, voting, representative.
---------------------------------------------------------------------------------------------------------
REGISTRATION FEE: Transferable, But Non Refundable after Nov. 12, 1999
$95.00 - All participants (FDP Members and Non Members)
**********************
Please send your check to arrive by Friday, Nov. 12, 1999. Sorry – no credit cards. Please give your accounting office Federal Tax I.D. No. 042103594, which is the I.D. number for the Massachusetts Institution of Technology. Make check payable to FDP-MIT and send with registration form to:

Jackie SandsStaff Associate, FDP/GUIRRThe National AcademiesFO2014-KWashington, D.C. 20418(202) 334-3486; (202) 334-1505 (fax)email: jsands@nas.edu For office use only: Date Check Received:Check from:Check date:Check No.: Check Amount:Website address corrected !Listserve email address corrected !

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