Tulane Engineering Registration Form

Registration Form

Tulane Engineering Forum

September 21, 2001

School of Engineering, Tulane University


 
      Registration Information
 
      To register, please complete the information below,
      print the form and mail to:
 
     Jenny Kottler
     Tulane University
     School of Engineering
     105 Sycamore Dr.
     Metairie, LA 70005
 
      If paying by VISA/Mastercard,
      print the form and fax to:
 
      504-835-1401
 
      Individual Registration
 
      General Public Registration:
       $200.00 until August 20, 2001
       $225.00 after August 20, 2001
 
      Tulane Alumni Registration:
       $175.00 until August 20, 2001
       $200.00 after August 20, 2001
         Graduation Year 
 
      Corporate Registration
 
      $1,000.00 Corporate Sponsor
         Admits: 4 guests to the sessions, one couple to speakers' reception,
         and company recognition in program literature.
      $2,500.00 Forum Sponsor
         Admits: 10 guests to the sessions, one couple to speakers' reception,
         and logo recognition in program literature.
      $5,000.00 Forum Patron
         Admits: 10 guests to the sessions, one couple to speakers' reception,
         logo recognition in program literature, and recognition as host of closing reception.
      $10,000.00 Forum Underwriter
         Admits: 10 guests to the sessions, one couple to speakers' reception,
         logo recognition in program literature, and recognition as host of Forum lunch.
 
 
      Title 
      First Name  MI 
      Last Name  
      Company/University 
      Address 1 
      Address 2 
      City  
      State  Zip 
      Contact Phone  Fax 
      Your E-mail   
 
      Breakout Session Preference
 
      Morning Concurrent Breakout Session
            A         B         C 
      Afternoon Concurrent Breakout Session
            D         E          F 
 
      Payment:
 
      Number of Tickets   Ticket Price $  Total $
 
      Check payable to "Tulane School of Engineering"
      VISA/Mastercard
      VISA/Master Card Number 
      Expiration(Month/Year) 
      Card Holder Name 
 
 
 
Signature:____________________________________________________________
 
 
Date:_________________________________________________________________