Please send registration form and payment to: (PLEASE PHOTOCOPY THIS FORM AS NEEDED)
Post: Roberta Spencer, System Dynamics Society
Milne 300 - Rockefeller College, University at Albany - SUNY, Albany, New Y ork 12222 USA
FAX: +1-518-442-3398 Phone: +1-518-442-3865 E-mail: office@ systemdynamics.org
29th International Conference of the System Dynamics Society
Washington, DC July 24 - 28, 2011
Special Scholarship* Educator Registration Form
First Name: Last Name:
Salutation (Dr., Ms., Mr. etc.): Familiar first name:
(to appear on your badge)
Position or job title: Organization:
Postal Address: City/State:
Country: Postal Code: E-mail:
Telephone: FAX:
(country code - area code - local number)
In case of emergency, please contact: Name: Telephone: Relationship:
(country code - area code - local number)
Check here if you are a first-time participant at the International Conference of the System Dynamics Society.
Check here to decline receiving an Abstract Proceedings Book. [1] (One-day registration does not include Abstract Book.) Full proceedings are online post-conference.
(For office use only) 11 Received registration approval from Lees Stuntz on: *Must be approved before processing.
Banquet Dinner: - -
raaias ak Dinner Choice _| You (no extra charge) Guest(s) (please purchase a Social Program ticket below)
Indicate meal choice,
nuneber and name’oe Non-vegetarian # and name(s)
guest(s). Vegetarian # and name(s)
Payment Details:
A . ‘ On or before | June 21 to | After July 13
Registration Options and Fees| ~y,n.-20 July 12 | andon-site | Subtotal Credit card: pacterCard Diners Club
Visa American Express
One Day Registration (includes
Wednesday Conference and Thursday . . «le saitearuuaber
q Workshops but not Tuesday Banquet) Full | US$125" | US$140" | USS175° juss See ENE
price starts at $250. Price shown reflects
scholarship discount. sigranire:
Tuesday Night Banquet USS60 US$70 US$80° Juss
(Optional) expiration date:
Full Conference (includes Tuesday
night Banquet) Full price starts at $500.
Price shown reflects scholarship discount,
US$250° | _US$280" | USS350" Juss
Check enclosed (in US$ drawn on a US bank payable
to System Dynamics Conference)
Option #2.
: Wire transfer (We will send bank details.) All sending and
Social Program Ticket for Guest’) ussio0 | ussi10 | US$120° luss receiving bank transfer fees/charges are the responsibility of
the registrant.
2011 Society Membership Please consider becoming a member; fees vary | Please note: Online
January 1 ~ December 31, 2011 with income. Please call the office or visit [USS Scotts tt egieraas can he baad or bagi
www.systemdynamics.org for the correct amount. the Society’ ‘office.
TOTAL PAYABLE uss
System
Dynamics
Society
“Full conference fee and one day registration fee have been discounted by 50% due to System
Dynamics Society ip. Must be app d before p i
“Social Program or Banquet tickets for guest(s) will be sold on-site only if available.
“For anyone NOT registered for the conference. The Social Program ticket permits guest
attendance at all of the Social Program events (including Monday Buffet and Tuesday Banquet).
