Design Interactive Systems 18 - 20 August 1997

To register please complete this form, one person per entry and send it to the address below. You will not be registered until full payment has been received. Fully paid registrations received by 21st July will receive advanced confirmation by post. If you are completing a paper copy please use block letters (print) or type.

Family (Last) name   First name  
Affiliation  
Contact Address  
City/Town   State/Province  
Zip/Postal Code  
Country  
Phone   Fax  
Email  
Registration fees:
    early (before 25 July)   later (after 25 July)
ACM/SIGCHI members $400 $600
Non members $500 $750
Student $200 $200

Method of Payment; please indicate how you you will pay
a cheque/money order in US$. Please make payable to DIS 97
using my credit card
  • VISA
  • MasterCard

    Card # _____________________________
    Expiration date _____________________________
    Name of person who wholds the card _____________________________
    Signature _____________________________
If you are using Email via the WEB page or otherwise please DO NOT include credit card details. We cannot guarantee the security of your credit card details. Please send payment authorisation via mail or Fax (as appropriate) to:

Suzanne Schuon,
Administrative Associate
School of Information
University of Michigan
550 East University,
Ann Arbor, MI 48109-1092
USA

tel +1-313-647-3110
fax +1-313-764-2475
e-mail sues@umich.edu

Cancellation and Refund policy

Please notify Suzanne Schuon at the University of Michigan in writing if you wish to cancel your registration. Cancellations received by 21st July will receive a full refund less a handling fee of $30. No refunds will be made for cancellations received after 21st July.

Please print this form and fax or email to Suzanne Schuon.

(For office use only)
ck / mo # _____________________________
Issued by _____________________________
Authorization # _____________________________
Date _________   Initials ________
charge* cash noshow* rplcd* bill
refund* comp ackn* on site