Complete a separate form for each participant.
You may also register online but
be sure to send in your check to the address below.
Last Name
First Name
Social Security No.
Title
Organization
Address
City
State
Zip
Daytime Phone No.
Fax No.
E-mail Address
Registration Fee: $75.00 (includes two lunches and a banquet). Make checks payable to the Statistics Faculty Fund. Return this form with payment by mail to: