PICSIM 2005 Online Registration Form

Please complete all fields.

1. School Name:

2. Head Delegate:

a. Phone Number:

b. Fax Number:

c. E-Mail Address:

3. School Street Address:

City:

State:

Zip:

4. Registration Option (Please Choose One):
Early Reg. (by Oct. 20th -- Waived School Fee and Preference in Choosing Committees/Positions)
Priority Reg. (by Dec. 1st -- $50 School Fee and Preference in Choosing Committees/Positions)
Regular Reg. (by Jan. 1st -- $50 School Fee and Position Assignments Arranged by Availability)
Late Reg. (by Jan. 23rd -- $75 School Fee and Position Assignments Arranged by Availability)

5. Fees:

Fee	Qty		Cost Per		Subtotal
School Fee	1	X	Early: $0 Reg./Priority: $50 Late: $75	=	$
Delegate Fee	students attending	X	$65.00	=	$
			Total	=	$

If you have any questions, please contact Jeanne-Paloma Zelmati at PICSim@whigclio.princeton.edu or jzelmati@princeton.edu or (212) 203-1169 (cell).

*SECONDARY REGISTRATION FORM & COUNTRY ASSIGNMENT APPLICATIONS WILL BE SENT UPON CONFIRMATION OF REGISTRATION*