| 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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| Last name: | |
| First name: | |
| Institution: | |
| Street address: | |
State/Province: |
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Zip/Postal Code: |
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| Country: |
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| email: |
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| Telephone
No.: |
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| Fax
No.: |
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| IPCO X fee: $225 |
Your payment: $__________ |
| Summer School fee: $100 |
Your payment: $ __________ |
| Total: $ __________ | |
| Credit
Card: |
MasterCard Visa (circle one) |
| Credit
Card Number: |
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| Expiration
Date: |
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Cardholder's Signature: |