COMPSAC 2001 REGISTRATION FORM

ITEM RATE AMOUNT
Advanced Registration
(before September 25, 2001)
Late/On-Site Registration
(after September 25, 2001)
Conference/Workshops: *
Members ** US $500.00 US $600.00 US $_______
Non-Members US $625.00 US $750.00 US $_______
Student Members *** US $150.00 US $200.00 US $_______
One Half-Day Professional Development Seminar (PDS ____ ):
Members ** US $90.00 US $110.00 US $_______
Non-Members US $105.00 US $135.00 US $_______
Student Members *** US $60.00 US $75.00 US $_______
Each Additional Reception Ticket on October 8, 2001 US $30.00 US $35.00 US $_______
Each Additional Banquet Ticket on October 10, 2001 US $60.00 US $65.00 US $_______
       
Total Amount US $_______
* Registration fee includes admissions to all technical sessions, a copy of the proceedings, coffee breaks, conference reception, and banquet.
Student registration fee includes admissions to all technical sessions, a copy of the proceedings, coffee breaks, but excludes conference reception and banquet.
** IEEE Member or IEEE Computer Society Affiliate Member must include membership number in order to register at the member rate.
IEEE or IEEE Computer Society Affiliate Membership No. _________________
*** Student must be IEEE student member in order to register at the student rate.
IEEE Student Membership No. __________________

 REGISTRANT INFORMATION

Name: ___________________________________________________
                          Last/Family                 First                 Middle Initial

Affiliation: _________________________________________________

Internal Mailing Address: ______________________________________

Street Address: _____________________________________________

City: ___________________ State: ________ Zip: _________________

Country: __________________________________________________

Telephone: ______________________ Fax: ______________________

Email: ____________________________________________________

 PAYMENT INFORMATION

Please pick one method of payment:

____ Check:

Checks must be drawn from a US bank and in US dollars only.
Checks must be payable to "IEEE Computer Society - COMPSAC 2001".

 
____ Credit Card:

____ Master / ____ Visa

Card Number: _______________________________ Expiration Date: ___________

Card-Owner's Signature: _______________________________________________

Total Amount: _______________________________ Date: ___________________