*Required Fields

                 First Name     
                  Last Name   
             Street Address   
                       City           State  
                        ZIP   

              IEEE Affiliation  

                    School Name 
         
      Attending Dinner Saturday, April 25th, 2009(yes/no)    

           Number of attendees      Vegetarian(yes/no) 

              Do you need a ride from the Airport (yes/no)   

      Inbound Flight Details   

      Outbound Flight Details  

              *E-Mail Address  
                    Phone No   
                         URL   
                Your Message