Short Course Registration Form

"Automated Multivariable System Identification: Basic Principles with Control and Monitoring Applications",
Thursday, September 23, 1999, 8:30 am - 5:30 pm,
Maryland Inn, 58 State Circle, Annapolis, Maryland 21401, Phone: 800 847-8882.

Personal Information

Title: (Prof, Dr, Mr, Ms, Other): __________

LAST name: ________________________ , First name:_________________________

Company/Institution: ____________________________________________________

Department: _______________________________________Mail Code:_____________

Address: _____________________________________________________________

_____________________________________________________________

City: _______________________________________Country: _____________________

Phone: ____________________________Fax: _____________________________

e-mail: ____________________________________________________________

Registration and Fees

Course registration fee received:

On or before August 23 ............ $300
After August 23 ..........................$375
Course fee, student .......................$150
Attendees of the Neural Net and Process Control Consortium receive a 25% discount except students.
Includes course materials and coffee breaks

Payment

Amount of Payment in US Dollars: $ _________

Payment Method (choose one)

• __ A check or money order in US Dollars is enclosed.
• __ I am wiring Payment in US Dollars (contact Dr. Larimore for detailed information)
• __ Charge my credit card:
  • Card type (VISA, MasterCard, AmExp, etc.) _____________________
  • Card Number __________________________
  • Expiration Date ___/___ (month/year)
  • Signature __________________________
  • Exact name on card ______________________________

Send registration form plus payment to:

Dr. Wallace E. Larimore, President
Adaptics, Inc
1717 Briar Ridge Road
McLean, VA 22101 USA

TEL: 703 532-0062; FAX: 703 536-3319
EMAIL: larimore@adaptics.com
Web Site: http://www.adaptics.com

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