Computer History Museum - 2001 Fellow Awards Banquet

Computer History Museum
2001 FELLOW AWARDS BANQUET

Table Reservations

Please register using this form. Payment information can not be submitted online for security reasons. An individual reservation for each guest must be submitted. Kindly reply by October 15, 2001. This is currently not a secure site. Please print completed form and mail, fax, or phone in your reservation. Reservation submission information below.

Name and Contact Information of Host (* indicates required information)

(One person per form please)

Last Name:*
First Name:*
Name, as you would like it to appear on your banquet badge:
Mailing address: *
City: *
State: *
Zip: *
Country: *
Home Phone:*
Email:*
Affiliation:
Other Phone:
Please select a dinner entree

Reserve a table
Yes, I would like to reserve a table at Computer History Museum 2001 Fellow Awards event.
	Wizard $4,750: Table of ten in a priority location. Includes acknowledgement in printed program.
	Guru $3,250: Table of ten. Includes acknowledgement in printed program.
	Rising Star $1,750: Table of ten.

Guests Information Please complete your guest list including entree choice. We ask that you complete your guest list as completely and as soon as possible, including full names for event badges and entree choices. If you do not have complete information at this time, please complete your guest list with entree information by Monday, October 15. Guests that are not pre-submitted by Monday, October 15 will be required to go through a registration and badging line at the event. Additionally, guests that do not have specified entree choices by Monday, October 15, will be served the "Latticed Breast of Chicken" dinner.
Guests' Names	Contact Number	Entree Choice

Payment Method (select one)*

This is currently not a secure site. Reservations may be submitted by fax, phone, or mail. Print out the information requested after you submit the form. If you are not submitting on line then please provide the information below.

Credit Card Type: _____________________________
Credit Card number: ___________________________
exp. date (MM/YY): _________
amount authorized: _________
name as it appears on card: _____________________
signature: ___________________________________

Submit Reservation
Please submit reservation form no later than October 10, 2001. This is currently not a secure site. Reservations may be submited on-line, by fax, phone, or mail. Registration confirmation and a receipt will be sent to you prior to the event.

Online:	After you submit your information, please print out the payment information request and mail, fax, or phone in the payment information.
By Fax:	Print these .shtmls and fax them to: +1 650 604 2594 (credit card authorization required)
By Phone:	Call +1 650 604 2714 (credit card authorization required)
By Mail:	Please print these.shtmls and mail them to: Fellow Awards 2001 Registration Computer History Museum P.O. Box 367, Moffett Field, CA 94035, USA

Your donation in excess of $100 per person is a tax-deductible contribution. Federal ID# 77-0507525