Name: _____________________________________

Job Title: __________________________________

__________________________________________________

___ I have enclosed full fee payment of US$1,900 (Payable to Rutgers University)

___ I have enclosed a deposit of US$500 (Payable to Rutgers University). Balance due by May 28, 2001)

___ I have enclosed late fee payment of US$2,200 (after June 5, 2001 (Payable to Rutgers University)

___ I have enclosed a copy of my bank transfer of U.S. $__________ made payable to Rutgers University

___ I wish to pay by ___ MasterCard ___ VISA ___ American Express

Expiration Date ____________________________

Cardholder’s Name _________________________

Cardholder’s signature:______________________

Billing Address ZIP Code ____________________

HOUSING INFORMATION:

___ I would like to have lodging reservations made for me at: __ Ramada Inn North Brunswick

__ Newell Apartments

(dormitory-style rooms)

Roommate Choice: _______________________________________________

I understand that if I do not indicate a roommate one will be selected for me.

Gender (for roommate selection): ___ male ___ female

___ I prefer a single room.

___ I prefer hotel accommodations. Please send me hotel choices and prices.

I will be arriving:_________________________________________ I will be departing:_______________________________________

__ I require auxiliary aids and services due to a disability. Please contact me at the above address.