10^th Deep-Sea Biology Symposium

Registration and Housing Form

Name: Title: (Dr., Prof., Ms., Mr.,)

Institution:

Mailing Address:

Telephone: Fax:

E-mail:

Names of accompanying persons:

Housing Preference (check all that apply)

I will arrange my own hotel room or other accommodations:

I request on-campus accomodation at SWOCC or OIMB for the following nights:

August 24 25 26 27 28 29 30

On campus housing will be assigned in the order that requests are received. Please rank

(1^st choice, 2^nd choice, etc.) all housing units for which you would like to be considered:

Single occupancy room at SWOCC Single occupancy room at OIMB

Double occupancy room at SWOCC Double occupancy room at OIMB

Dormitory "room" at OIMB

I have requested double occupancy; please assign me a roommate

I have requested double occupancy and will arrange my own roommate

My roommate is registering and paying separately; his/her name is:

Registration and Housing Fees

Early Registration fee before June1 ($240.00 regular; $200.00 student) $

Late Registration fee after June1 ($270.00 regular; $230.00 student) $

On-campus housing deposit ($50.00 x persons) $

Banquet ($40.00 x persons) $

(includes excursion, reception, evening restaurant shuttles)

TOTAL REGISTRATION FEES & HOUSING DEPOSIT $

Amount paid by check* (U.S. funds) $ Date Mailed:

Amount paid by bank transfer** $ Transfer Date:

(sorry... the University of Oregon does not accept credit cards)

*All checks should be made payable to Oregon Institute of Marine Biology and mailed to:

Craig Young, P.O. Box 5389 Charleston, OR 97420

**Direct bank transfers should be made in U.S. Dollars to:

Umpqua Bank, North Bend, Oregon

Routing Number: 123205054

Account Number: 550000277

Comment Line: make sure the bank includes your name!

Please check responses for accuracy then click this button to submit:

Thank you. Your registration and housing will be confirmed by e-mail.