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PRE-REGISTRATION IS NOW CLOSED - PLEASE REGISTER ON-SITE AT UW-MADISON

NORTH AMERICAN ANNUAL MEETING
Association for Symbolic Logic
March 31 - April 3, 2012
University of Wisconsin, Madison

PRE-REGISTRATION

You may submit this form online or print it and return it, by mail or fax, to:

Association for Symbolic Logic, Box 742, Vassar College, 124 Raymond Avenue, Poughkeepsie, NY 12604 USA, Fax: (845)437-7830

All pre-registrations must be received by March 21, 2012. After that, you must register at the meeting at UW-Madison .

Name :
Affiliation (For Badge)
Address 1:
Address 2:
City, State - Zip:
Country:
E-mail Address:

Registration Fees in US Dollars

Member - $35
Emeritus and Retired- Free
Outreach Member - Free
Unemployed Member - Free
Student Member - Free
Non Member - $40
Student Non Member - Free
Add $10 for Non student registrations postmarked after February 28, 2012
   
   
   

Payment

Check or Money Order (in US dollars drawn on a US bank, made payable to the Association for Symbolic Logic)
Credit Card Type
Credit Card Number
Expiration Date Name as it appears on credit card

Signature ___________________________________________________________________________________________

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