California Library Association, Information Technology and Management Sections
Video Teleconference on Libraries and the Internet: Management and Policy Issues

Registration Form

Name: _______________________________________________

Library: ____________________________________________

Mailing Address: ____________________________________

_____________________________________________________

Daytime Phone: ______________________________________

Fax: ________________________________________________

E-mail: _____________________________________________

Select teleconference location:

_____ Pasadena Public Library
_____ Sacramento Public Library
_____ West Valley Community College
_____ California Polytechnic University, San Luis Obispo

Please send applicable fee, payable to CLA, with this registration form by Sept. 4, 1996.

_____ $35 CLA Members
...... CLA Member No. (on CLA mailing label): _________________
_____ $45 Non-CLA Members
...... $50 at the door if space is available.

Method of Payment: (No American Express)

_____ Check enclosed
_____ VISA
_____ Mastercard

Card No.: _______________________________ Exp.Date:_______________
Signature: _______________________________________________________
....(as shown on credit card)

Mail this form and your check to:
 Internet Video-Conference
California Library Association
717 K Street, Suite 300
Sacramento, CA 95814-3477

or

Fax it with your credit card information to: (916) 447-8394

Purchase orders are not accepted. A copy of this form must accompany payment.

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