IGA 2001 Conference
Gothic Cults & Gothic Cultures
Registration Form


Please complete and print out one form for each registrant and mail the completed registration form to:

Conference Services, Halpern Centre
Simon Fraser University
8888 University Drive
Burnaby, B.C. Canada V5A 1S6

Fax: (604) 291-3420

General Information

I do want to have my name, including my e-mail address, on the Delegate List.
(If you do not mark this box, your name will be excluded from the list.)

PLEASE TYPE or PRINT LEGIBLY.

Miss Ms Mrs. Mr. Dr. Prof.

First name (as it will appear on your name badge and the participant list):

Family name:

University:

Department:

Mailing Address:

City:

Province/State:

Country:

Postal/Zip Code:

Phone:

Fax:

Email:

Special Needs (if any):

 

Audio-visual Supplies/Requirements

I am a presenter; I require the following audio-visual equipment for my presentation (check as required):

Slide projector
Overhead projector
VHS/VCR
Other (please specify):

Conference Registration Fee

Early Fee (on or before May 31)
Regular Fee (from June 1 and on-site)

Presenter/Faculty/Research Fellow/Other (early: Cdn $150 or US $100; regular: Cdn $175 or US $115)
Student* (early: Cdn $75 or US $50; regular: Cdn $90 or US $65)

* A copy of my valid student card is attached/enclosed.

Special Events

Please indicate the number of people planning to attend each special event:

Welcome Reception at SFU, Harbour Centre:   people (price included in conference fee)

Sherlock Holmes Exhibition, Vancouver Museum:   people x Cdn$10.00 or US$7 =

Friday, Sunset Dinner Cruise:  people x Cdn$68.15 or US$45 .50 =

Total Payment

 Cdn dollars or
  US dollars

Method of Payment

Cheque or Bank Draft (payable to Simon Fraser University)
VISA (13 or 16 digits)   MasterCard (16 digits)

Sorry, Simon Fraser University does not accept American Express or Diners Club.

Card No.

Expiry Date   Issue Date (MasterCard only)

Cardholder's Name (if different from registrant above)

 

Signature (mandatory for credit card)

_________________________________________________________

 

Payment is due by Wednesday, JUNE 6, 2001