2004 ASSIST Conference Registration Form

Please complete the following registration form and submit it to the ASSIST Coordination Site no later than November 5, 2004. All fields for each attendee are required. After you've finished, click Register at the bottom of the page to send the information to us. Click Clear to erase your entries and start over.

Select your institution:

Name 1:
Phone #:
Email:

Name 2:
Phone #:
Email:

Name 3:
Phone #:
Email:

Name 4:
Phone #:
Email:

Name 5:
Phone #:
Email:

If you will have 6 or more attendees from your campus, please complete a second form after submitting this one.

Please click Register below to submit the registration form to us. Click Clear below to erase your entries and start over.

Fee: $75 per person if paid by November 5
$85 per person if paid November 6 or later

Send registration fees to:
ASSIST Coordination Site
820 University Tower
Irvine, California 92697-1005

Make Checks Payable to:
Regents of the University of California
ASSIST Coordination Site
820 University Tower
Irvine, California 92697-1005

2004 ASSIST Conference Agenda

2004 ASSIST Conference Information