SAC 2002 EXTRA BANQUET TICKETS FORM Surname: _________________________ Given Name: _______________________ e-mail: _____________________________________ Extra banquet bickets @ $40 each: ( )x$40....$________ Method of Payment:[ ]Credit Card [ ]Cheque in Canadian funds (payable to "Memorial University of Newfoundland") Payment by Credit card (select one): [ ]Visa [ ]Mastercard Name on Card: __________________________________________ Card Number: ___________________________ Expiry Date: _____/_____(mo/yr) Cardholder's signature: ________________________________ ************************************************************************* Is a vegetarian meal required for the banquet? YES ___ NO ___ Please indicate any other special dietary requirements: ************************************************************************* Mail or FAX this form to: Yvonne Raymond Faculty of Engineering and Applied Science Memorial University of Newfoundland St. John's, NF CANADA A1B 3X5 Fax: 709-737-3056, Phone: 709-737-7467