REGISTRATION FOR INTERFACE 2003

To register on or before April 9th, 2004, please make checks payable to Interface 2004 and mail (together with this form) to: Interface 2004, P.O. Box 7460, Fairfax Station, VA 22039-7460, USA. Or if using a credit card, the form may be faxed to: (703) 993-1700 (attention: Elizabeth Quigley). No refunds available after April 30, 2004.
Visa, MasterCard, or Discover Credit Cards are accepted. In this case, please supply the following information:
Credit Card Type ______ Master Card ______ Visa ______ Discover Card

Card Number ___________________________ Expiration Date _________________

3 digit Number on Back of Card for Discover Card Users______________________________

Cardholder's Name ______________________________________________________

Signature ______________________________________________________________

Billing Address _________________________________________________________

Email Address(for receipt purposes)__________________________________________________
(Please type or print legibly.)
To register after April 9th, 2004, but before May 14th, 2004, please register by FAX as indicated above (however, late fees apply) or contact Liz Quigley, (703) 993-1680, or via email, liz@galaxy.gmu.edu.
To register after May 14th, 2004, email, liz@galaxy.gmu.edu.

REGISTRATION FOR INTERFACE 2004

(Please type or print legibly.)

Name (as will appear on nametag) _______________________

Affiliation __________________________________________

Address ___________________________________________

Please check if ____ work or ____ home

City _________________________ State _____ ZIP ________

Phone __________________ e-mail _______________________

========= On or before April 9th, 2004 ====================

____ Interface Foundation of North America (IFNA) Membership $35

____ Interface Registration (for IFNA Members) $215

____ Interface Registration (for Members of Cooperating Societies - see list below) $250

____ Interface Registration (for Full-time Students) $110

____ Interface Registration (all others) $295

____ Registration for a Single Day of Interface (No Banquet, no CD) $130

========= After April 9th, 2004 ========================

____ Interface Foundation of North America (IFNA) Membership $35

____ Interface Registration (for IFNA Members) $265

____ Interface Registration (for Members of Cooperating Societies - see list below) $300

____ Interface Registration (for Full-time Students) $150

____ Interface Registration (all others) $350

____ Registration for a Single Day of Interface (No Banquet, no CD) $150

===============================================

____ Banquet (for Single Day Registrants or Guests) $50

========= Short Courses: On or before April 9th, 2004 ============

Leo Breiman and Adele Cutler, Random Forrests

____ Random Forrests (IFNA/Cooperating Societies Member) $165

____ Random Forrests (Non-IFNA/Cooperating Societies Member) $225

____ Random Forests (Full-Time Student) $75

Rafael A. Irizarry, Gene Expression Analysis

____ Gene Expression Analysis (IFNA/Cooperating Societies Member) $165

____ Gene Expression Analysis (Non-IFNA/Cooperating Societies Member) $225

____ Gene Expression Analysis (Full-Time Student) $75

Both Courses

____ Both Courses (IFNA/Cooperating Societies Member) $225

____ Both Courses (Non-IFNA/Cooperating Societies Member) $350

____ Both Courses (Full-Time Student) $100

========= Short Courses: After April 9th, 2004 ================

____ Late fee for short courses after 4/9/04 or when upgrading from 1 to 2 short courses $30

_____ TOTAL $_____

Notes:

For inquiries about registration, please contact Liz Quigley, (703) 993-1680, or via email, liz@galaxy.gmu.edu.

Registration for Interface includes all Interface sessions, the banquet, and the conference CD (mailed after the conference).

Full-time students: Please attach proof of your full-time student status - a letter from your department chair is required.

Participants in short courses must be registered for the meeting (at least for a single day).

On-site registration will be available.

If you select and pay for IFNA membership then you can register at IFNA rates for Interface and the courses (i.e., membership is effective immediately).

Cooperating Societies are: ACM, ASA, CSNA, ENAR, IASC, IMS, INFORMS, SIAM, and WNAR.

	========= On or before April 9th, 2004 ====================
____	Interface Foundation of North America (IFNA) Membership	$35
____	Interface Registration (for IFNA Members)	$215
____	Interface Registration (for Members of Cooperating Societies - see list below)	$250
____	Interface Registration (for Full-time Students)	$110
____	Interface Registration (all others)	$295
____	Registration for a Single Day of Interface (No Banquet, no CD)	$130

	========= After April 9th, 2004 ========================
____	Interface Foundation of North America (IFNA) Membership	$35
____	Interface Registration (for IFNA Members)	$265
____	Interface Registration (for Members of Cooperating Societies - see list below)	$300
____	Interface Registration (for Full-time Students)	$150
____	Interface Registration (all others)	$350
____	Registration for a Single Day of Interface (No Banquet, no CD)	$150

	===============================================
____	Banquet (for Single Day Registrants or Guests)	$50

	========= Short Courses: On or before April 9th, 2004 ============
	Leo Breiman and Adele Cutler, Random Forrests
____	Random Forrests (IFNA/Cooperating Societies Member)	$165
____	Random Forrests (Non-IFNA/Cooperating Societies Member)	$225
____	Random Forests (Full-Time Student)	$75
	Rafael A. Irizarry, Gene Expression Analysis
____	Gene Expression Analysis (IFNA/Cooperating Societies Member)	$165
____	Gene Expression Analysis (Non-IFNA/Cooperating Societies Member)	$225
____	Gene Expression Analysis (Full-Time Student)	$75
	Both Courses
____	Both Courses (IFNA/Cooperating Societies Member)	$225
____	Both Courses (Non-IFNA/Cooperating Societies Member)	$350
____	Both Courses (Full-Time Student)	$100

	========= Short Courses: After April 9th, 2004 ================
____	Late fee for short courses after 4/9/04 or when upgrading from 1 to 2 short courses	$30

_____	TOTAL	$_____