Last Name _______________________ First Name____________________ MI ____ Male _______ Female_________

Institution __________________________________________________________________________________

Street Address__________________________________________________ City_________________________________

State ________ Country____________________ Zip or mail code______________________________

Phone Number (    )______________ FAX Number (    )____________________ E:Mail Address____________________

Please PRINT below exactly how you would like your name & country to appear on the Congress badge

NAME: ____________________________________________ COUNTRY: _______________________________

Registration and Late Fees (includes Meals)

                                                       By March 15 1998                                     After March 15 1998                   U.S Dollars

Income Level                       Member, IACCP         Non-Member                Member, IACCP    Non-Member

Above $40,000                           $315                       $365                                $365                            $390              $_______

$25,000 -39,000                           $240                       $250                                $250                            $260                _______

$20,000 - 24,000                          $190                       $190                                $190                            $190                _______

Student*                                     $165                       $165                                $165                            $165                _______

Accompanying guest $50 in addition to fees for the registrant                                                                            _______

NOTE: This additional guest registration DOES NOT include meals. Accompanying guests will be allowed to pay cash at the dining room for any meals they wish to attend. It DOES include access to all Congress sessions, refreshment breaks, and campus facilities. It will also include an official Congress name badge.

Note: These fees include all meals (5 breakfasts, 4 lunches, 4 regular dinners, 1 special congress banquet)

Refunds, requested in writing, less a $25 handling fee, will be accepted until July 15, 1998.

*Western Washington University Psychology students admitted free to the sessions. All students must show proof of student status.

On-Campus Residential Accommodations (Please check) U.S. Dollars

___ Double Room, five-night package, August 3-7                                            $115 per person                         ________

___ Double Room, Extra Night(s), August 2____ August 8____                    $22 per night                              ________

___ Single Room, five-night package, August 3-7                                              $170                                            ________

___ Single Room, Extra Night(s), August 2____ August 8 ____                     $32 per night                              ________

___ I have made arrangements to share a room with_________________________________________________

On-Campus Meal Options (Please Check)

___Additional Congress banquet tickets                                                              $25 per person                           ________

___Dietary restrictions ___________________________________________________________

Optional Packages (Please Check)

___ Whale Watch Tour, Saturday, August 8                                                       $45 per person                           ________

___ Mt. Baker Bus Trip, Saturday, August 8                                                      $30 per person                             ________

                                                                                                                                                  TOTAL FEES $___________

____Bellingham Festival of Music. it is possible to arrange for the purchase of tickets at discount prices, and pay for them upon your arrival.

For planning purposes please indicate in which of the following-you are interested.(Please Check)

___Sunday, August 2, American Sinfonietta Beethoven program       ___Saturday, August 8, American Sinfonietta Beethoven  program

___August 3-7, Chamber or Ethnic music

Method of Payment (Please Check)

___Check Attached   ___Visa   ___ MasterCard      ___Purchase Order/P.O.#__________________________________

Card Number ____________________________________________ Expiration date ___/____/

Signature________________________________________

Please send this completed form to                         CSHBLT

IACCP '98
Conference Services,
Western Washington University
Bellingham, WA  98225-9042 U.S.A.