BROWN UNIVERSITY
Conference Services, Box 1864
Providence, RI  02912
FAX (401) 863-7300

Thirteenth Conference on Uncertainty in Artifical Intelligence
UAI '97
July 31- August 3, 1997
ON-CAMPUS HOUSING REGISTRATION FORM

PLEASE PRINT
NAME:___________________________________ 		

	Last	First	Middle Initial


SEX: M___   F___




MAILING ADDRESS:		
		


TELEPHONE NUMBER:  			
	Home:			Business:


ARRIVAL DATE: __________ 	TIME:________  	DEPARTURE DATE: ________________ 	

HOUSING:  All dormitories have semi-private bathrooms.  Each room has at least one single bed, dresser, desk and chair.  Each guest is provided with sheets, towel, pillow, pillowcase and, if needed, blanket.  Linen is not changed during the conference. 

_____ Nights in an air-conditioned single dormitory room @ $45.00/night	$_____ 

_____ Nights in a single dormitory room (no A/C) @ $36.00/night		$_____

_____ Nights in a double dormitory room (no A/C) @ $34.00/person/night	$_____
	

NAME OF PERSON SHARING WITH YOU:
		
Please assign a roommate for me.  
(If we are unable to assign you a roommate, you will be billed for a single room.


PAYMENT AUTHORIZATION:  Your room reservation must be guaranteed by completing this credit card authorization form.  Master Card and VISA only.  One night's payment is not refundable if cancellation occurs after July 20, 1996.

					
Credit Card Type _________________________
(Master Card and VISA only)		

Credit Card Number ___________	Expiration Date _______
		

			
Name on Credit Card (Please print)_____________________________


___________________________________________
Signature of Authorization
	

Please return this registration form by June 20, 1997:  

 ** Brown University, Conference Services, Box 1864, Providence, RI  02912 **

Other options:

* Fax:   (401) 863-7300.  
* Email: UAI97_housing@brown.edu
 

Reservations received by June 20 will be confirmed.  

Reservations for oncampus housing cannot be made by telephone. 

Any cancellations or changes should be made directly with Brown University Conference Services.

PLEASE RETURN THIS FORM BY JUNE 20, 1997
	
Please indicate if you have any special disability requirements: