Registration Form for AEWG – Anaheim/Los Angeles, CA, USA
11 – 13June 2013, Crowne Plaza Anaheim Resort
12021 Harbor Boulevard, Garden Grove, CA 92840
Speaker/Presenter Author/Co-author (Insert Xafter red boxes if applicable)
Participant Full Name:(Title, First Name and Family Name)
Accompanying Person Full Name:
Company, University or Organization:
Mailing Address(please include street number, city, state or province, and post/zip code):
Business
Home
Country(if not USA):
Email Address:(for sending receipts)
Telephone #:
Fax #:
Indicate any special needs (for example disabilities, dietary) / Email to at least 10 days before the meeting
Indicate if planning to register
onsite / Regular registration fees apply
Description
(Fees are in US dollars) / Early Registration Fees/person (if received on/before May 24, 2013) / Regular Registration Fees/person (ifreceivedon/after May 25, 2013)
Full Meeting Participant–includes lunch, morning/afternoon coffee breaks during the meeting on 6/11 & 6/12, and banquet on 6/12 / $195 / $215
Full MeetingStudent– includes lunches, morning/afternoon coffee breaks during the meeting on 6/11 & 6/12, and banquet on 6/12 / $160 / $180
Vender Exhibit Table
Sponsor a Coffee Break / $ 275
$ 350 / $ 325
$ 350
BanquetOnly Accompanying Persons–(6/12) Provide name(s) / $50/person / $ 55/person
TOTAL FEE to PAY(see next page for payment options) / US$
Note both the registration form and the fee must be received by May 24 for the early fee schedule.
Payment Information -Payment options are by check, international money order (US$payable to AEWG), credit card (onsite process only) or bank transfer (see below).
By Mail:
The completed registration form (page 1) and a check in US dollars should be mailed to:
AEWG
C/O Dr. Jerry Huang
The Boeing Company
2201 Seal Beach Boulevard
M/S 110-SK56
Seal Beach, CA 90740
USA
By Credit Card:
(See instruction for onsite payment/registration below)
By Bank Transfer:
Bank Transfer(fax or email the completed registration form, page 1, see onsite contacts below) / Bank Name / Wells Fargo Bank N.A.(If address is required, use: Wells Fargo Bank, 9350 E. Arapahoe Rd., Greenwood Village, CO 80112, USA)
Account Number / Email to for Number
Account Name / Email to for Name
Routing number (RTN): / 121000248
SWIFT Code / WFBIUS6S
Transfer description / Conference feesfor AEWG – Anaheim/Los Angeles 2013 for (please insert participant full name here)
A receipt will be produced and sent to you by email mail (or provided onsite)based on the data given on the first page after we receive your payment. Please email to alert that you have done a bank transfer.
For onsite payment/registration
Please send this form by e-mail (PDF format) or fax to:
Dr. Jerry Huang, AEWG, e-mail: , Fax: 562-797-1991.
Refund policy
Requests for refunds of prepaid registration fees must be submitted (see mailing address above) in writing and must be received no later than May31, 2013, and are subject to a $10 processing fee. No refunds will be available after this date.
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Registration form for AEWG-55,Anaheim/Los Angeles, CA, USA – June 2013