Collective Behavior/Social Movement Workshop (CBSM)

University of California, Davis - August 19 - 21, 1998

ADVANCE REGISTRATION FORM

Three Ways To Register

1. Register by Phone

Call (530)757-3331 between 9am - 4pm. Please have your credit card number ready.

2. Register by FAX/TDD

Complete this form and FAX to (530)757-7943 Credit Card Payments Only.

3. Register by Mail

Mail completed form and payment to:

Conference and Event Services

ATTN: CBSM

423 First Street

Davis, CA 95616

Cancellation Policy

Written requests for refund of registration fees must be received by June 15, 1998, and mailed or faxed to:

Conference & Event Services (CBSM)

423 First Street

Davis, CA 95616

Fax: (530)757-7943

Refunds (minus a $35.00 processing fee) will be made after the conference and typically take 2-4 weeks to process.

For questions please call (530)757-3331.

AFTER June 15, 1998, REFUNDS WILL BE GRANTED ON A CASE BY CASE BASIS.

Registration will be handled by the Conference & Event Services Office. Credit cards are acceptable for conference registration fees. Fee includes access to all conference proceedings. Housing accommodations are available; please see separate registration form for rates and package information. A separate form is required for each registrant.

(Please print legibly or type)

Name: (for name badge)________________________________________

..................................Last .......................................First .............................MI

Address: _________________________________________________

......................Street Address

________________________________________________________________

City ...................................State .........................Country..................... Zip Code

Institutional Affiliation: _____________________________________________

Phone: (____) __________________..........Fax: (____ )_____________________

Please include area, city and country codes

Email: ___________________________

Registration Fee

Per Person	By June 15, 1998	After June 15, 1998
Regular	$75.00	$100.00	$ ______
Student	$55.00	$75.00	$ ______
Shuttle to SanFrancisco ...........8/21/98	$15.00	$15.00	$ ______ (optional)
		TOTAL:	$ ______

Payment by Credit Card

Visa

Master Card

American Express

Payment by Check / Money Order

Make checks payable to "UC Regents"

Card #: ___________________________________

Expiration: ________________________________

Card Holder Signature: ______________________________________

Name as Printed on Card: ____________________________________

Name of Registrant (if different)________________________________