The Pointe Room in the Pyramid - California State Univ., Long Beach

REGISTRATION FORM

Name (as you’d like it on badge):_______________________________________________________

Email Address:___________ Telephone:_

Mailing Address:____________________________________________________________________

Business/Academic Affiliation (for badge):________________________________________________

Registration Fee if postmarked with payment on or before April 18th

(includes lunch and parking)

___Regular @ $60

___SCASA member @ $50 (SCASA member is not the same as ASA member)

___Full-time student @ $20

Buffet Lunch is included, but to be sure we have enough of each entrée please check one:

___ Chicken with Basil

___ Vegetarian Stuffed Pasta Shells (cheese, but no meat)

(You may join SCASA for $12 per year and pay the member price: http://www.sc-asa.org/. Send the membership form and a $12 check payable to SCASA in the same envelope with this workshop registration form and the $50 member price for the workshop payable to Workshop in Applied Statistics. Send both checks to Anita Iannucci.)

Registration fee if postmarked after April 18th or paid at the Workshop

(limited number of lunches available for later registrants; must pay for own parking)

___Regular or SCASA member @ $65 ___Full-time student @ $25

Please mark a lunch choice above even though lunch is not guaranteed for registrants after April 18th.

Make your check payable to “Workshop in Applied Statistics” and return it with this form to:

Anita Iannucci

Center for Statistical Consulting

University of California

Irvine, CA 92697-5105

Please enclose a self-addressed stamped envelope (we strongly recommend a home address) for return of your registration confirmation and directions to the event.

Refund requests cannot be honored after April 18th. If you are making a refund request, please send a self-addressed stamped envelope and also email Anita at iannucci@uci.edu.

For further information: Anita Iannucci at iannucci@uci.edu or 949-824-1682 (afternoons).

SCASA’s web site: http://www.sc-asa.org/; Workshop web site: http://www.stat.ucla.edu/~rgould/asw2005