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Conference Registration Form

To register for the SCVMMI Conference, please fill out and submit the form below. Conference registration also includes a $200 fee and should be mailed to the following address (payable to The SCVMMI Conference):

Dr. George Towfic
Computer Science Department
MS# 1792
Clarke University
1550 Clarke Drive
Dubuque, IA 52001

Registration for this event must be completed by May 20, 2011. Registration will not be completed until the registration fee is received.

First Name:  
Last Name:  
Affiliation:  
Current Position:
Address:  
City:  
State:  
Zip:
Phone:  
Fax:  
E-mail:  

I wish to attend the whole conference: 

I wish to attend keynote speeches only: 
 

 
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