Please email this form to:	register@w3.org.

***Subject line should read:  WAI Launch Meeting***

First Name:
Last Name:
Title:
Company:
Address:
Address2:
City:
State:
Zip:
Country:
Email:
Phone:
Fax:
URL:

Meals
____  I prefer vegetarian meals.

Speical Services - Very Important

Interpreter Needed: (check one)

____ Oral

____ Sign Language

____ None

Adapted Program:

____ Braile Program

____ Large Print Program

____ Disk (ASCII)

____ None

The WWW6 Conference Commieet is kindly offering an extension of the early bird registration rate to those attending (including speakers) the WAI event.  Please complete this section to receive the early bird discount.

***This does not qualify as registration to the WWW6 Conference.***

Do you plan to attend the WWW6 Conference? 
____Yes		____No