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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

 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
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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