17th International System Safety Conference August 16-21, 1999 Orlando, Florida System Safety at the Dawn of a New Millennium www.system-safety.org

Registration fees (except as noted) include attendance at all technical sessions, tutorials, Tuesday, Wednesday and Thursday luncheons, Wednesday evening dinner and entertainment, Thursday evening awards banquet and one copy of the conference proceedings.

1. Active participants are SSS members, authors, panel members and session chairs. (Circle each that applies.)
2. Does not include Wednesday evening dinner and entertainment or Thursday evening awards banquet.
3. Does not include Wednesday evening dinner and entertainment or Thursday evening awards banquet. Include the name of educational institution on this form and attach copy of student identification.

Name _______________________________________________________(This spelling will appear on your name tag,

Company ________________________________________________ along with company, city and state or country)

Address _________ ____________________________City___________________________ State/Prov______ __________

Country__________________ Zip + 4________________ Phone ________________ Fax _____________

Email: _______________________________Any special needs (include physical & dietary) _______

Conference Registration Fee (Conference sponsors receive a 20% discount, Exhibitors receive a 10% discount) = $_____________

Extra Conference Proceedings No. ____@$70/copy = $ ______

Extra Luncheon Tickets (Specify Days: Tues ___,Wed___, Thurs___) No. ____@$20/Adult = $ _______

Extra Awards Banquet Tickets (Thursday, August 19, 1999) No. ____@$30/Adult = $ _____ _

Extra Wednesday evening dinner and entertainment tickets (Wednesday, August 18, 1999)

No._____@$Free/Child (12 and Under), No._____@$20/Youth (13-16), No._________@$45/Adult = $____

System Safety Society Membership (new or renewal, please circle) No. @$65/Year = $_____

Total Fee = $_____

_____My payment is enclosed. Checks should be made payable to: CPS, Inc.

_____I prefer to pay by credit card: _____ VISA______ Master Card ______American Express

Card Number: ________________________________________ Expiration Date: _________________

Printed Name: _ Signature: __________________________________ Date: ____________

Cancellation Policy: Should you be forced to cancel your conference reservation after payment of the fee, you will be entitled to a refund less a $50 administration fee until 15 June 1999. 50 % refunds will be provided until 15 July 1999. No refunds will be provided after 15 July 1999. A substitute may be designated at any time.

Hotel Reservations: A limited number of rooms have been reserved at the conference hotel, The Holiday Inn International Drive Resort, at a special conference rate of $71.00. To take advantage of this special rate, it is important that you mention you are attending the conference and that you make your reservations by July, 15, 1999.