Registration Form
The Ninth International Conference on Thai Studies
#7282
Sunday-Wednesday, April 3-6, 2005
Holmes Student Center, Northern Illinois University, DeKalb, Illinois

Three Easy Ways to Register
1. Online
2. BY FAX 815-753-6900.
3. BY MAIL University Outreach, Northern Illinois University, DeKalb, IL 60115.

NOTE: To make any changes or additions to your registration AFTER you have registered, please send an email to: outreachregistration@niu.edu

The conference registration fee includes conference documents, reception, one lunch, one dinner and refreshments, totebag, and conference CD of abstracts. All participants in the conference must register. All registrations will be confirmed by payment. Transportation between DeKalb and Chicago may be requested separately below with this form.

Name/title____________________________________________________________

Organization_______________________________________________________

Address___________________________________________________________

City_____________State______Zip:code(+4)__________Country ____________

Day Phone___________________Fax_________________________

email: ______________________________

[ ] Conference fee, Professional: $150 per person.
[ ] Conference fee, Student: $95 per person.
[ ] I cannot attend. Please send me the conference CD of abstracts, $25. (Available after April 15, 2005)

Optional fees:
Transportation from Chicago. An NIU vehicle will depart for the Holmes Student Center, DeKalb
[ ] Saturday, April 2, 5 pm, from Chicago O'Hare airport, $25
[ ] Sunday, April 3, 11 am, from the A.A.S. meeting at the Hyatt Regency Chicago, $25
[ ] Sunday, April 3, 12 noon, from Chicago O'Hare airport, Terminal 5, Door "E".$25
[ ] Saturday, April 2, 7 pm, from Chicago O'Hare airport, Terminal 5, Door "E". $25
Transportation from DeKalb. An NIU vehicle to O'Hare airport
[ ] Wednesday, April 6, 4 pm, from NIU Holmes Student Center, $25
[ ] Thursday, April 7, 9 am, from NIU Holmes Student Center, $25

Number of people requesting transportation:______x $25 = Total Cost:________________
University transportation is available by reservation only, prepaid, non-refundable. For transportation at other times, call DeKalb O'Hare Limousine, 815-758-0631. No public transportation is available between DeKalb and Chicago O'Hare airport.

Extra Meal Tickets for Guests
[ ] Luncheon, Monday, April 4, $20 Number of tickets for your guest_________
[ ] Dinner banquet, Tuesday, April 5, $25 Number of tickets for your guest__________

Please verify the payment amount in US dollars.
_____Total registration costs
_____Cost of transportation from/to Chicago
_____Additional tickets to luncheon/banquet for guests
_____Total submitted via check/credit card payment

____________Total amount

[ ] Check payable to Northern Illinois University
[ ] Charge fee to: [ ]VISA [ ]MasterCard [ ]Discover [ ]American Express
Note that credit card payments will be processed in US dollars.
Account # _______________________________________ Exp. date__________________
Name as it appears on the card:__________________________________________________
Is the billing address the same as the address above? [ ]Yes [ ]No
If no, please provide your billing address in the spaces below:
Address:_______________________________________________
Signature______________________________________________

International Wire Instructions for incoming funds to NIU: 

Bank Name:             Bank One
Bank Address:          One Bank One Plaza, 2 South Dearborn, Chicago, Illinois  60670-0002

ABA #:                      071000770
SWIFT CODE:            FNBC US 44

For Credit to:
Account Name:          The National Bank & Trust Company
Account Number:       11762

For Further Credit to:
Account Name:          Northern Illinois University
Account Number:       6500000

It is critical that the information in red also be included in the transfer.

Reference:
Note a reference on the transfer that helps identify the university department or individual expecting the funds.  “THAI CONFERENCE, EVENT#7282”

Further Info:
Before you transfer please send the following information in an email to mvolk@niu.edu
1. the country the money is coming from
2. the approximate date you are transferring
3. US dollar amount being sent

Additional Needs:
[ ] Check here is you have special needs that are regulated by the American with Disabilities Act.
[ ]Yes, I require a formal invitation in order to obtain a US visa.
Legal Name (as it appears on your passport) if different from above: ______________________
[ ]Male [ ]Female

Accommodations:
Contact the Holmes Student Center directly to reserve guest room accommodations.
Holmes Student Center
Northern Illinois University
(Phone) 815-753-1444
(Fax) 815-753-5099
(Email) hotel@niu.edu


The deadline for registration is March 3, 2005. For any registration forms postmarked after this date, a late fee will apply.

Cancellations and refunds: If you must cancel your registration, please submit written notice by March 28, 2005 in order to receive a refund of conference registration fee, minus a $15 handling fee. Written notice may be sent by email to LASEP@niu.edu, by fax to the attention of Registrar, University Outreach, 815-753-6900, or by mail to the address above. No refunds will be issued for cancellation notices received/postmarked after April 3. Substitutions are permitted at any time for conference registration at no penalty. Payments for transportation are NOT refundable.

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