Housing Registration form for "Milky Way Surveys: The Structure and Evolution of Our Galaxy" The 5th Boston University Astrophysics Conference Boston, Massachusetts, USA June 15-17, 2003 DEADLINE for Early Registration: April 30, 2003 Name __________________________________________________________________ Organizational affiliation ____________________________________________ Mailing Address: Street:________________________________________________________________ City/Town:__________________ State/Province:___________ Zip/Country Code:___________ Country:__________________ Telephone:________________ E-mail address:_____________________________ Arrival Date:______________ Time: ____________________________________ Departure Date:____________ Time: ____________________________________ Please indicate which nights you request housing in the Student Village: Sunday, June 15th ___ Monday, June 16th ___ Tuesday, June 17th___ H. Total Nights ___ x $51.00/night = _____ Please indicate for which days you need a parking permit: Sunday, June 15th ___ Monday, June 16th ___ Tuesday, June 17th___ Wednesday, June 18th___ P. Total Days ____ x $10/day = _____ Housing+Parking Fee total (add H + P) = _______ Please select a payment option: _____Please Bill my Credit Card I authorize Boston University to charge my credit card for the cost of the conference fee. Credit Card type (Visa, MC, DC, other) ______________ (select one) Account # _________________ Expiration _________________ Name on Card ______________ Signature __________________ Date _______________ _____Check enclosed (payable to "Boston University: Milky Way Conference Housing") Please email completed form to: kpaci@bu.edu -or- FAX completed form to: Kimberly Paci at 617.358.2811 -or- Surface mail completed form (to arrive prior to 4/30/03 to meet the Early Registration deadline) to: Kimberly Paci, Business Administrator Institute for Astrophysical Research Room 514, CAS 725 Commonwealth Ave Boston University Boston, MA 02215 USA Reminder: Cancellation of paid housing registration fees before April 30, 2003 will be fully refunded. After April 30, 2003 paid housing registrations that are cancelled will be charged for the first night housing, only.