Please mail this form by April 5th to:

Paul Chiasson Computer Science Department Worcester State College  486 Chandler Street Worcester, MA 01602-2597

Phone: (508) 929-8560 e-mail: pchiasson@worcester.edu  fax: (508) 929-8156

 

Name: ___________________________ Position:__________________________ Company:_________________________ Address: _________________________ _________________________________ _________________________________ City: _________ State: ____ Zip: _______

Phone:  (        )__________ Fax:  (        )_____  E-mail: _______________________________  Company representatives attending conference (Up to three )  _____________________________________   _____________________________________  ______________________________________

Options (Circle appropriate amount):

Exhibit Table Only (includes exhibit table and conference nametags for 3)		$200
Demonstration or Presentation Room (includes exhibit table and nametags for 3)		$300
Added Options (fill in all that apply)
Additional vendor's representatives beyond the 3 included in registration ($30 each) Names:	How many? _____	Total $_____
Guest tickets for Saturday luncheon ($15 each)	How many? _____	Total $_____
Guest tickets for Friday dinner ($15 each)	How many? _____	Total $_____
Total amount due		$______

Check one:
 ____ Amount enclosed. (Check made to CCSC with notation for CCSCNE-2002) 
 ____ Please invoice company. 
Additional Needs: (Please indicate any special requests.)
  _____________________________________________________
Would you like to sponsor a part of the conference?       Yes:_____ No: ________
(Sponsorships for the Friday reception, Friday and Saturday refreshment breaks, Programming Contest, and Poster Session may be available.  If you check yes, we will call you.)