 

\documentclass[12pt]{article}

\marginparwidth 0pt
\oddsidemargin  -15pt
\evensidemargin  0pt
\marginparsep 0pt
 
\topmargin   -1in
 
\textwidth   6.5in
\textheight  11.0 in

\begin{document}
\begin{center}


${\cal REGISTRATION ~  FORM }$  \\[3ex]
{\Large \bf Category Theory and Computer Science 2002 } \\[1ex] 
{\bf August 15--17, 2002, University of Ottawa, Ottawa, Canada.}
\\[.5ex] {\bf Student Preconference:  August 12--14, 2002.}
\end{center}

\vspace{2ex}


\noindent
\begin{tabular}[t]{ll}
{\bf Name:} & $\underline{\hspace{5in}}$\\[3ex]
{\bf Affiliation:} & $\underline{\hspace{5in}}$\\[3ex]
{\bf Address:} & $\underline{\hspace{5in}}$\\[3ex]
& $\underline{\hspace{5in}}$\\[3ex]
{\bf Telephone/Fax:} & $\underline{\hspace{5in}}$  \\[3ex]
{\bf E-mail:} & $\underline{\hspace{5in}}$\\[5ex]
\multicolumn{2}{c}{
  We can accept payment by {\bf Cash,
Cheque, Visa, Mastercard} } \\[3ex]
{\large \bf Registration:} & All amounts in Canadian
Dollars ({\bf Early  Registration} ends June 30.)
\\[3ex] {\bf Early} \ Conference Fee  & \$275.00  \ \ 
\fbox{\rule{0pt}{5pt}\    } \quad \qquad  {\bf Student}
Conference Fee  
  \$120.00  \ \
\fbox{\rule{0pt}{5pt}\    } \\[3ex]
{\bf Late} \ \ Conference Fee  & \$300.00  \ \
\fbox{\rule{0pt}{5pt}\    }\quad \qquad \ {\bf PreConference}
Fee   \hspace{3ex}
\$100.00  \ \
\fbox{\rule{0pt}{5pt}\    }\\[5ex]
   {\bf Total Payment:} & $\underline{\hspace{2in}}$\\[3ex]
{\bf VISA/MC \#:}& $\underline{\hspace{5in}}$\\[3ex]
{\bf Name:} & $\underline{\hspace{3in}}$ \ \ {\bf Exp}
$\underline{\hspace{.5in}}~\slash
\underline{\hspace{.85in}}$\\[3ex]\\ 
\multicolumn{2}{c}{{\bf Cheques \& Money Orders:} Make them payable to:  
University of Ottawa.}\\[2ex]
\multicolumn{2}{c}{\bf Mail or Fax Registration Forms and/or Cheques   
to CTCS02 Conference Coordinator } \\[2ex]
  &    Gillian S. Murray, Conference Coordinator (CTCS02)\\
& Laboratory for Research in Statistics and Probability\\
& 5230HP, Carleton University\\
& 1125 Colonel by Drive\\
& Ottawa ON CANADA K1S 5B6\\[2ex]
& {\bf Phone:} \ (613) 520-2167  \quad
  {\bf Fax: }\ (613) 520-3822 \\[1ex] 
& {\bf E-mail:}\ \ \ {\sf gmurray@math.carleton.ca}   
   





\end{tabular}

\vspace{8ex}

 

 

\end{document}