AAECC-16 CONFERENCE

(Applied Algebra and Error Correcting Codes) February 20-24, 2006 Las Vegas, Nevada

Registration Form (please print or type)

Name:

____________________________________________________________________________________________

Affiliation:

____________________________________________________________________________________________

Last

Mailing Address:

First

Middle Initial

_________________________________________________________________________________ _________________________________________________________________________________ City/State/Zip Code

Country

Business Phone: ______________________________________

FAX:

___________________________________

Email Address:

_________________________________________________________________________________

Registration Fee:

$450.00 USD

Form of payment:

“ Check (payable to University of Hawaii)

(Includes welcome reception, lunches on Tuesday, Thursday and Friday, Banquet, daily refreshments and conference materials)

“ I hereby authorize University of Hawaii the use of my credit card account: “ VISA

“ MasterCard

Credit Card No.: ___________________________________________________ Expiration Date (Mo/Yr): _________________________ Signature:

__________________________________________________________

Send registration form and payment to:

UH Conference Center 2550 Dole Street, Sakamaki C-403 Honolulu, HI 96822 Phone: FAX:

(808) 956-8204 (808) 956-3364

UHCC I.D. #: Please indicate luncheon/banquet choice:

C07806

“ Standard

“ Vegetarian

Disability accessibility assistance required: “ Yes “ No If you would like assistance due to a mobility, hearing, or sight impairment, you are warmly encouraged to contact the Conference Center at (808) 956-8204 two months prior to February 20, 2006. Deadline for advance registration is: Must be postmarked by January 20, 2006. Form of payment must accompany the registration form. Credit card numbers submitted with registration form will be processed upon receipt. Registrations will not be processed without payment. Refunds: Requests for refunds must be received by February 3, 2006, in writing. No refunds will be made thereafter. Refunds will be mailed. Please allow approximately three to five weeks for processing.