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%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
% To fill this form, you will have to search for the "WRITE" commands
% and change their parameter to the appropriate values.
% You still will have to circle the tutorial choice and the type of
% registration by hand.
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

\newcommand{\WRITE}[1]{}
\renewcommand{\WRITE}[1]{{\textcolor{blue}{#1}}}


\begin{document} 

\sf

\textbf{
\begin{center}
{\Large QEST 2006 Registration Form ~~ (fill one form for each attendee)}\\
3rd International Conference on Quantitative Evaluation of SysTems\\
September 11-14, 2006  ~ --- ~
University of California, Riverside, CA, USA
\end{center}
}

\textbf{NAMETAG INFORMATION
(as you want it to appear on your nametag)}

\begin{tabular}{|p{1.2in}|p{5.9in}|}
\hline
Name                     &  \WRITE{Your name} \\
\hline
Organization             &  \WRITE{Your organization} \\
\hline
Address                  &  \WRITE{Your city, state, country} \\
\hline
\end{tabular}

\medskip

\textbf{ATTENDEE INFORMATION
(notifications will be sent to the email address you provide)}

\begin{tabular}{|p{1.2in}|p{5.9in}|}
\hline
Firstname                &  \WRITE{Your first name} \\
\hline
Middlename               &  \WRITE{Your middle name} \\
\hline
Lastname                 &  \WRITE{Your last name} \\
\hline
Address                  &  \WRITE{Your street address} \\
\hline
City                     &  \WRITE{Your city} \\
\hline
State or province        &  \WRITE{Your state or province} \\
\hline
Country                  &  \WRITE{Your country} \\
\hline
Postal code              &  \WRITE{Your postal code} \\
\hline
Phone                    &  \WRITE{Your phone} \\
\hline
Fax                      &  \WRITE{Your fax} \\
\hline
Email                    &  \WRITE{Your email} \\
\hline
\end{tabular}

\medskip

\textbf{EVENT REGISTRATION FEES
(fill-in the dashed lines)}
%\renewcommand{\WRITE}[1]{{\_\_\_\_\_\_\_\_}}

\begin{tabular}{@{}|@{}l@{}|@{}r@{}|@{}}
\hline
\begin{tabular}{p{3.1in}}
  \textbf{Tutorials, Sept.\ 11} ~
  (includes tutorial materials, lunch, coffee break)
~  ~~~~~ \textbf{061MPCQ11}
\end{tabular}
& 
\begin{tabular}{p{3.3in}r@{~~}r}
% PLEASE ERASE "150" AND LEAVE THE TRACK BLANK IF YOU DO NOT ATTEND TUTORIALS
  Choose the track (A or B) you plan to attend       & \$&   \WRITE{150} \\
  morning: \WRITE{A or B} ~~~~~~~~ afternoon: \WRITE{A or B}
\end{tabular}
\\
\hline
\begin{tabular}{p{3.1in}}
  \textbf{QEST 2006 Conference, Sept.\ 12--14} ~
  (includes proceedings, welcome reception,
  lunches, coffee breaks, banquet and museum visit)
  ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ \textbf{061MPCQ10}
\end{tabular}
&
\begin{tabular}{p{3.3in}r@{}r}
% PLEASE ERASE ALL AMOUNTS FROM THE FOLLOWING "WRITE"S EXCEPT THE CORRECT ONE
  Early registration (by August 1, 2006)            & \$&   \WRITE{525} \\
  Early student registration (by August 1, 2006)    & \$&   \WRITE{350} \\
  Registration (after August 1, 2006)               & \$&   \WRITE{625} \\
  Student registration (after August 1, 2006)       & \$&   \WRITE{450} \\
  Institutional sponsor registration                & \$&  \WRITE{1500}
\end{tabular}
\\
\hline &\\[-2ex]
\begin{tabular}{p{3.1in}}
  Additional banquet and museum visit tickets 
\end{tabular}
& 
\begin{tabular}{p{3.3in}r@{}r}
  Number \WRITE{number} @ \$ 110 each =                       & \$&  \WRITE{number}
\end{tabular}
\\
\hline
\multicolumn{1}{r}{
\begin{tabular}{@{}p{3.1in}}
Banquet choices for you and additional guests: ~
  Beef \WRITE{number}  
  Fish \WRITE{number} 
  Vegetarian \WRITE{number}
\end{tabular}
}
&
\multicolumn{1}{|r|}{Total payment due ~~~~~~~~~ \$  \WRITE{number}}
\\
\cline{2-2}
\end{tabular}

\medskip

\textbf{PAYMENT METHOD}

\textbf{Credit Card:} Fax the form to +1-951-827-4657
(your statement will show this transaction as ``Regents U.C.'').
\\[1ex]
\begin{tabular}{l @{} p{2.9in} @{} l @{} p{3.4in} @{} }
Name: & \WRITE{Credit card name} & Signature &
\\ \cline{2-2} \cline{4-4}
\end{tabular}
\\[1.0ex]
\begin{tabular}{l @{} p{2.27in} @{} l @{} p{0.5in} @{} l @{} p{0.5in} @{} }
Circle: VISA or MASTERCARD ~
Number: & \WRITE{Credit card number}   &
Exp.~Month: & \WRITE{Month} & Year: & \WRITE{Year}
\\ \cline{2-2} \cline{4-4} \cline{6-6}
\end{tabular}

\medskip

\textbf{Check:} In US dollars only, made payable to
``Regents U.C.'', sent to:\\
\begin{tabular}{l}
   University Extension, Conferencing Services
\\ Attn: QEST 2006 ConferenceExtension
\\ 1200 University Avenue
\\ Riverside, CA 92507,~ USA
\end{tabular}

\medskip

\textbf{Cancellation Policy:}
Refunds upon notification of cancellation in writing:
100\% refund less a \$40 handling fee, before August 11, 2006; ~
50\% refund from August 11, 2006 to September 1, 2006; ~
no refund after September 1, 2006.
 Substitutions allowed at any time.

\medskip

\textbf{Questions? Send email to conferencing@ucx.ucr.edu or call
+1-951-827-4105.}


\end{document}