Please complete and print the form below, and fax it to:

Peter Fisher
Department of IEOR
Columbia University
500 West 120th St
New York, NY 10027, USA

Fax Number:  212-854-8103

Alternatively, you may 
(1) email your information to Peter Fisher:  peter@ieor.columbia.edu

  or

(2) Phone Peter Fisher:  212-854-2942

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IPCO X  Registration form   --  Student


Last name:
First name:
Institution:
Street address:
State/Province:

Zip/Postal Code:

Country:

email:

Telephone No.:

Fax No.:

IPCO X fee:  $225
Your payment: $__________
Summer School fee: $100
Your payment: $ __________

Total: $ __________
Credit Card:
   MasterCard     Visa   (circle one)
Credit Card Number:

Expiration Date:

Cardholder's Signature: