6TH INTERNATIONAL CONFERENCE ON

LATTICE PATH COMBINATORICS AND APPLICATIONS

July 12 - 14, 2007

REGISTRATION FORM

Name: ____________________________________________________________________________________

(first) (last)

University/Organization: ____________________________________________________________________________________

Address:_________________________________________________________________________________________________

________________________________________________________________________________________________________

City: ________________________________ State/Province: ______________________ Postal/Zip Code: __________________

Country: _____________________________ Telephone: (______)__________________

Email: _______________________________ (include country and/or area code with telephone)

Date of Arrival: _______________________________ Date of Departure: _______________________________

Guest Name ________________________________________________________________________

(first) (last)

Board (cost is per night)

Check One:

¨ Carnegie Hotel $79 (single or double, circle one) $ ________

¨ Stone Hall $25-single $15-double (circle one) $ ________

Share Room with___________________________________________________________________

(first) (last)

(If you do not have a roommate preference, one will be assigned to you)

Registration (Includes the cost of a banquet at the Carnegie, reception Thursday evening at the Carnegie, coffee breaks, 3 lunches (Thursday and Friday at the Main Meal, Saturday a box lunch), Appalachian Trail Hike, transportation to and from the airport, and Bluegrass band performance.)

Check One:

¨ Registration by June 15, 2007 $140.00 (regular); $75.00 (student); $60 (accompanying person) $ ________

¨ Registration after June 15, 2007 $160.00 (regular); $95.00 (student); $80 (accompanying person) $ ________

Grand Total (Board plus Registration) $ __________

Please list any Special Needs: (Vegetarian Meals, handicapped room etc) _____________________________________________________________

_________________________________________________________________________________________________________________________

Cancellations and Refunds: Registration fees will be refunded, less a $20.00 administration fee, if cancellation is received in writing no later than July 1, 2007. After that date, registration fees are non-refundable. All refunds will be processed after the conference.

PAYMENT METHOD

Please make checks in U.S. funds payable to: East Tennessee State University.

(Please check appropriate box) VISA MasterCard Check (US only) Cash on Site

Card #: ____________________________________________________ 3 digit Security Code on card ___________

Expiration Date: ______________________________________

Print Cardholder Name: _______________________________________

Billing Address: ______________________________________________________________________

Please mail, e-mail, or fax completed registration form with payment to:

Phone: (423) 439-4349 ETSU Math Department, Box 70663

FAX: (423) 439-8361 East Tennessee State University

Email: godbolea@etsu.edu Johnson City, TN 37614- 1701, USA

Do not email credit card information because security cannot be guaranteed. You may fax or telephone credit card information.