CogSci97 REGISTRATION FORM

  Name            ______________________________________________________________

  Department      ______________________________________________________________

  Institution     ______________________________________________________________

  Street address  ______________________________________________________________

  City            _______________________ State/Province _______________________

  Postal code     _______________________ Country        _______________________

  Phone number    _______________________ Fax number     _______________________

  Electronic mail ______________________________________________________________

  REGISTRATION

  Registration fee for members of Cognitive Science Society ($100)    ______

  Registration fee for nonmembers of the Society ($155)               ______

  Registration fee for nonmembers outside North America ($183)        ______

  Additional fee if form sent after July 1, 1997 ($30)                ______

  ON-CAMPUS HOUSING AND DINING

  Single room from night of August 6 to morning of August 10 ($240)   ______

  Single room from night of August 6 to morning of August 11 ($280)   ______

  Shared room from night of August 6 to morning of August 10 ($192)   ______

  Shared room from night of August 6 to morning of August 11 ($223)   ______

  Extra charge for single room on night of August 4 ($42)             ______

  Extra charge for single room on night of August 5 ($42)             ______

  Extra charge for single room on night of August 11 ($42)            ______

  Extra charge for shared room on night of August 11 ($31)            ______

  TOTAL AMOUNT DUE                                                    ______

  Your sex __ Assign a roommate __ Preferred roommate (if any) _____________________

  Method of payment   ___ Visa   ___ Mastercard   ___ Check (US dollars)

  Card number _____________________________________

  Expiration date __________ Signature _____________________________________________

  If you are paying by personal or traveler's check, please make it out to Stanford 
  University and send it air mail to:

     Cognitive Science 1997
     CSLI / Computational Learning Laboratory
     Ventura Hall, Stanford University
     Stanford, CA 94305 USA

  If you are paying by credit card, you may mail your form to the above address or 
  fax it to Cognitive Science 1997 (Attn: Susan Stansbury) at (415) 725-2166.