Registration Form (29th SIA Annual Conference, Duluth, MN, June 1-4, 2000)

WE CAN NOT ACCEPT INTERNET OR PHONE REGISTRATIONS ** MAIL ONLY**

PLEASE PRINT OUT FORM ON YOUR PRINTER AND MAIL WITH YOUR PAYMENT TO THE ADDRESS BELOW

Society for Industrial Archeology/SIA 2000
Department of Social Sciences
Michigan Technological University
1400 Townsend Drive
Houghton, MI 49931-1295 USA
PLEASE PRINT CLEARLY

Name: ____________________________________________________________

Spouse's name if also registering: ______________________________________
(must include separate registration fee to attend conference events)

Affiliation (will be printed on your name tag): ___________________________

Mailing Address: ___________________________________________________

Mailing City: ____________________ Mailing State/Province: ______________

Zip/Postal Code: _________________ Country: __________________

Daytime Telephone: _________________________________________

Electronic Mail Address: ____________________________________________

This is my first SIA Annual Conference (Please circle) YES or NO

For each selection below please list quantity and total charge

Note: Each Friday tour has a maximum limit of tour attendees,
please list your first 4 preferences (1 = 1st Choice, 2 = 2nd, 3rd, 4th, ....)
Fri. Iron Range tour 1 - Registrant's Choice: __________ Spouse's Choice: __________
Fri. Iron Range tour 2 - Registrant's Choice: __________ Spouse's Choice: __________
Fri. Iron Range tour 3 - Registrant's Choice: __________ Spouse's Choice: __________
Fri. Duluth tour 1 - Registrant's Choice: __________ Spouse's Choice: __________
Fri. Duluth tour 2 - Registrant's Choice: __________ Spouse's Choice: __________
Fri. Duluth tour 3 - Registrant's Choice: __________ Spouse's Choice: __________
Fri. Duluth tour 4 - Registrant's Choice: __________ Spouse's Choice: __________

TOTAL REGISTRATION AND EVENTS $___________

SIA MEMBERSHIP DUES (see below): $__________

Membership Class (check one):

SIA Members outside of US and Canada please add $10 for additional surface mailing charge.

ADDITIONAL CONTRIBUTIONS (General Fund or Scholarship Fund): $__________

TOTAL AMOUNT ENCLOSED: $__________ (conference reg., events, dues & contributions)

Make checks (IN US DOLLARS DRAWN ON A US BANK) payable to Society for Industrial Archeology.

If paying by credit card, please include: (NOTE: WE MUST HAVE ALL THE INFORMATION BELOW TO PROCESS YOUR CREDIT PAYMENT)

Name of Cardholder:______________________________Type of Card (MC or VISA)___________


Account Number: _______________________________ Expiration Date (MM/YY): _____________

Cardholder Signature: ________________________________________