Registration Form

(SRCOS /ASA)

2002 Research Conference in Statistics
"Statistics in Science"

Hosted by

Mississippi State University

in

Natchez, Mississippi
June 2-5, 2002


Name: _________________________________________________________________
Address: _________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Phone: _________________________________ (Home)
_________________________________ (Office/Work)
FAX: _________________________________
e-mail: _________________________________

Fees: (Write dollar amount on appropriate lines)
Full registration (includes banquet): $100.00 ($110.00 after May 1, 2002) $__________
One-day registration (does not include banquet): $35.00 ($40.00 after May 1, 2002) $__________
Student or retired (banquet extra): $0.00 $__________
Additional banquets: Total additional banquet fees $__________
Adult ($32.00 each) Number of additional adults __________
Student ($16.00 each) Number of students __________
Children, ages 6 - 12 years ($7.50 each, under 6 free) Number of children __________
Total amount enclosed: $__________

Make checks payable to SRCOS SRC 2002 and return check and completed form to:

Dr. Jane L. Harvill
Department of Mathematics and Statistics
Drawer MA
Mississippi State, Mississippi 39762