Brain-Mind Institute
2022 http://www.brain-mind-institute.org/
Registration Form

Instructions:  (1) Fill in this form (* is required entries)
(2) Pay through PayPal connected from BMI web (Registration page) (3) E-mail to weng@cse.msu.edu (using Subject: BMI registration) with two attachments:
    (both (a) and (b) are required to count as a valid registration.)
(a) the payment confirmation email from PayPal
(b) this form fully filled.

First Name*:__________	Last Name*:____________      Contest entry name: ____________         Contest web site: _____________
Your name that you like to appear on your badge:____________
Company Name:_________
Address*:___________
Address:___________
City*:___________	State:________ Postal code*:________	
Country*:___________
Telephone*:__________	Fax:___________ Email*:_________
For full-time student registration only:  The type of your full-time student ID (you attach with your email):____________ The expiration date of your full-time student ID:____________	 The type of document to verify your spring full-time status or equivalent: ____________
Registration Fees
Registration Types	By June 19, 2022	After June 19, 2022	
3-course (A: Region A)	$2795	$3003	
2-course (A: Region A)	$2080	$2289	
1-course (A: Region A)	$1191	$1399	
3-course (B: Region B)	$1379	$1501	
2-course (B: Region B)	$1040	$1144	
1-course (B: Region B)	$596	$699	
3-course (FTS: Full-Time Student)	$150	$165	
2-course (FTS: Full-Time Student)	$100	$110	
1-course (FTS: Full-Time Student)	$50	$55	
AIML Contest (per entry, three courses free for the head of the team entry)	$150	$165	
GENISAMA VCML-100 purchaser	$100	$105	
 Courses you register (only BMI 831, BMI 861, BMI 871):________________________ Mark (using bold) the table entry above that corresponds to the cost of your registration.

The total cost:__________________ 
Signature:__________________ Date:_________________
For more information, visit  http://www.brain-mind-institute.org/program-registration.html