SIA Study Tour of Sweden REGISTRATION FORM 3-17 September 2002
Please mail completed form and deposit to: Don Durfee, SIA Headquarters, Michigan Technological
University, Department of Social Sciences, 1400 Townsend Drive, Houghton, MI 49931-1295.

I (we) enclose payment for $800 per person as a deposit to hold ____ place(s) for the SIA Sweden Tour.

_____ :WE DESIRE A DOUBLE ROOM.

_____:I DESIRE A SINGLE ROOM, FOR WHICH I UNDER-STAND THERE IS A SUPPLEMENTAL CHARGE

_____ I DESIRE TWIN ROOM OCCUPANCY; MY ROOMMATE'S NAME IS: ___________________________

FIRST PERSON NAME: _______________________________________________

STREET ADDRESS: _____________________________________________________

CITY: ______________________________ STATE:__________ ZIP: ______________

SECOND PERSON NAME STREET ADDRESS

__________________________________________________________________ I / WE HAVE READ THE TOUR CONDITIONS
CITY STATE ZIP/POSTAL CODE DESCRIBED AND AGREE WITH THEM:

__________________________________________________________________ __________________________________________________
PHONE EMAIL SIGNATURE (S) DATE

PAYMENT METHOD: CHECK CREDIT CARD (specify type) VISA MASTERCARD DISCOVER

NAME ON CREDIT CARD _________________________________________

AMOUNT ENCLOSED ________ CREDIT CARD #____________________________________________________ EXP Date ___________
(IN U.S. DOLLARS)

SIGNATURE FOR CREDIT CARD _________________________________________________________________________________________