REGISTRATION FORM Not an on-line form.  Print this out and fax or mail to address below. Name and Title: _________________________________________________ Department: ___________________________________________________ School or Organization: _________________________________________________ Street Address: _________________________________________________ City, State, Zip: __________________________________________________ Phone: (_____)_____________________Office (_____)______________________Home (_____)______________________Fax E-Mail Address (required):__________________________________ Course: ______ April 25-26, Missing Data, $650 ______ July 14-18 Event History & Survival Analysis (SAS), $1300  ______ July 21-25, Categorical Data Analysis, $1300  ______ July 28-August 1, Event History & Survival Analysis (Stata), $1300  How did you first learn about this course? _____________________________________________________________ Return this form with a check or money order payable to Statistical Horizons 530 New Gulph Rd. Haverford, PA  19041-1617 Fax:  215-573-2081 If you wish to pay by credit card, please enter information below: Credit Card Number ___________________________________ Expiration Date ______________________________________ Cardholder Name ____________________________________ Billing Address ______________________________________