Atlanta, GA

Please make your check payable to CCSC for the amount of $50.� Mail your check along with this form to Dr. Julia Benson-Slaughter at:

�� Department of Mathematics/Computer Science/Engineering

�� Georgia Perimeter College, Dunwoody Campus

�� 2101 Womack Road

�� Dunwoody, GA 30338

�� julia.benson-slaughter@gpc.edu

�� (770) 274-5152

Company Name ________________________________

Contact Person _________________________________

Address _______________________________________

�� _______________________________________

Telephone _____________________________________

E-mail ________________________________________

Number of people attending: ��

Any special requirements?

_______________________________________________________________________

________________________________________________________________________

If you are interested in attending the conference banquet or luncheon, please include $25 per ticket to the banquet and/or $10 per ticket to the luncheon in your payment.