REGISTRATION FORM
American Association of University Women
SA/SEC Regional Conference, June 11-13, 2004

Early Conference Registration Date is May 10, 2004

Hotel registration cut-off date is May 12, 2004
Rate for June 10-14, 2004 is $119/night plus 14% tax
Call 1-800-706-2899, Monday - Saturday only
Request "American Assn. Of University Women" room rate -- DO NOT ASK for "AAUW" rate
Rooms have two queen beds and can accommodate up to four persons
Visit www.gatechhotel.com for directions and hotel information and amenities

REGISTRATION INFORMATION Name__________________________________ Address_______________________________ City_________________State____ZIP______ Phone_____________________________Day  _________________________________Night E-MAIL_______________________________ (E-Mail address is required to receive confirmation of receipt of registration - No confirmations will be sent by United States Postal Service) Do you hold a branch, state, regional, or Association position?                   YES / NO If YES, please list all below:____________ ___________________________________ ___________________________________ Do you have special needs with meals or meetings?                                    YES / NO If Yes, please explain below:___________ ___________________________________ ___________________________________ Only prior arrangements can be honored during the conference.

REGISTRATION COST Postmarked by 5/10/04                  $125  $________ Postmarked after 5/10/04               $150  $________ (Due to uncertainty of mail service, do not mail registrations by United States Postal Service after June 2, 2204)  On-Site Registration                       $175  $________ Registration fee includes: All materials, Friday Author Event, Saturday Breakfast, Saturday Lunch and All Day Breaks           GRAND TOTAL                               $_________