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PAYMENT OPTIONS <br />Credit Card Payment: (Choose t}pe of card.) <br />❑ VISA ❑ MasterCard ❑ Discover ❑ American Express <br />Account Number: - -- --- ---- ----_- ----- - - ---.-- -- <br />Expiration Date: <br />Authorized Signature: -- -- - --- - -- - - - - - _ -- <br />-or- <br />El Check payable to Indiana University #104-99 <br />Send payment and registration form to: <br />Conference Registrar <br />Indiana University Conferences <br />P.O. Box 249 <br />Bloomington, IN 47402 <br />FAX: (812) 855-8077 <br />PHONE: (812) 855-4661 or (800) 933-9330 <br />A limited number of registration scholarships are available. For further information, contact Paul Diebold at <br />(317) 232-1646. <br />SPECIAL NEEDS: <br />Please list any special needs for our attention(dietary, transportation, housing): <br />Cancellations must be received by September 17, 1999 to receive full refund. <br />