CONFERENCE SERVICES EVENT REGISTRATION Electrical Engineering Career Fair and Casino Night Tuesday, January 20, 2015 REGISTRATION DESCRIPTION The University of Washington Electrical Engineering Department has made arrangements to host the Electrical Engineering Career Fair and Casino Night in Seattle, WA. Registrations are nontransferable. Please complete and return this form along with full payment no later than Tuesday, January 13, 2015. Registrations received after this date are charged a $15.00 Late Registration Fee (plus applicable tax) and are only processed on a space-available basis. PARTICIPANT INFORMATION Please fill out a separate form for each person’s registration. Please type or print clearly. LAST NAME (SURNAME) FIRST NAME (PERSONAL NAME) BILLING ADDRESS CITY/STATE/ZIP/COUNTRY TELEPHONE INSTITUTE/COMPANY COMPANY REPRESENTATIVE 1 COMPANY REPRESENTATIVE 2 COMPANY REPRESENTATIVE 4 COMPANY REPRESENTATIVE 5 COMPANY REPRESENTATIVE 3 PLEASE DECSRIBE ANY ACCESIBILITY ACCOMIDATIONS YOU MAY REQUIRE: PACKAGE SELECTION Will you need a power source at your table/booth? Career Fair Only $600.00 = $ Includes gaming, hors d’oeuvres, hosted beer, wine and nonalcoholic beverages $300.00 = $ Career Fair and Casino Night $750.00 = $ $16.43 ($15.00 FEE PLUS $1.43 TAX) = $ Includes 6’ table, two chairs and bottled water Casino Night Only Late Fee After Tuesday, January 13, 2015 Total Enclosed Yes No   $ AUTHORIZED SIGNATURE _______________________________________ PRINT NAME ________________________________________________ By signing this form, you agree to the terms and conditions on page two of this contract. Your signature authorizes the University of Washington to charge your credit/debit card for costs incurred after this form has been signed. METHOD OF PAYMENT  Check (U.S. funds on a U.S. bank account payable to University of Washington. Please mail check with the Registration form.)  Visa  MasterCard (For credit/debit card processing, the address provided above must reflect the credit/debit card billing address.) Credit/Debit Card Number: Expiration Date: Please do not email this form. You may fax this form if paying by credit/debit card, but please DO NOT mail an additional copy. University of Washington  Box 354460  Seattle, Washington 98195-4460 Telephone 206-543-7636  Fax 206-897-1620  Email confhous@u.washington.edu Conference Services Registration Policy Guidelines Payment: Registrations will not be processed unless full payment is received with this registration form. Advance payment must be made in U.S. dollars by check or Visa/MasterCard. Checks must be drawn on a U.S. bank account, made payable to the University of Washington, and mailed with the registration form. The University of Washington charges $25.00 for all returned checks. Registrations paid by Visa/MasterCard may be faxed; however, please do not mail in an additional form. Confirmation: Once your registration and full payment have been processed, you will be sent an email confirmation. Cancellations and Refunds:  If the cancellation is received by the Conference Services Office on or before Tuesday, January 13, 2015, the payment will be returned, less a nonrefundable $9.50(plus tax) registration processing fee.  If the cancellation is received by the Conference Services Office after Tuesday, January 13, 2015, no refund will be issued. Privacy Statement: The University of Washington Department of Housing & Food Services Conference Services respects your privacy and will not sell or rent your personal contact information. Your personal contact information may be provided to the Conference Organizers, if requested. The University of Washington reserves the legal right for recovery of reasonable attorney fees, court costs and other reasonable collection costs including payment of collection agency fees. If faxing the form, please send to: If mailing the form, please send to: Questions? Please contact us at: CONFERENCE SERVICES Fax 206-897-1620 CONFERENCE SERVICES University of Washington Box 354460 Seattle, WA 98195-4460 CONFERENCE SERVICES Telephone 206-543-7636 Email confhous@u.washington.edu