|
AUTHOR
REGISTRATION IEEE
IMTC/2003 CONFERENCE REGISTRATION FORM Vail, Colorado, USA, 20-22 May 2003 NOTICE: REGISTRATION FORM MUST BE RECEIVED BY MARCH
31 _________________________________________________________________________________________________
Last Name First Name Initial _________________________________________________________________________________________________ Organization
Street Address _________________________________________________________________________________________________ City State/ Province Country Postal Code _________________________________________________________________________________________________ Phone Number Fax
E-mail Address IEEE
Member Number (to
receive Member Discount) All Fees are in U.S.
Dollars IEEE Non- Additional Registration
Total Member Member Paper Fee**
Conference Registration US
$ 520 US $ 620 _______ _______ After March 31 US $ 575 US
$ 675 _______ _______ Full registration includes a
CD and printed copy of the proceedings (no discount if not taken), entrance
to all sessions, coffee breaks, 3 lunches, Tuesday reception and Wednesday
reception and dinner. ** One author registration
will guarantee publication of up to two accepted papers. Each additional accepted paper with the
same registration will require a printing contribution of US $ 50. Paper Number and Title
covered by this Registration (your registration can cover only papers of
which you are an author) Paper Number: IM- First
Words of Paper Title: Paper Number: IM- First
Words of Paper Title: Additional Paper(s) covered
by this registration ($50 each - your registration can cover only papers of
which you are an author) Paper Number: IM- First
Words of Paper Title: Paper Number: IM- First
Words of Paper Title: Additional Proceedings
Indicate Number of Bound
Copies of the Proceedings _____ @ US $ 55 each _______ Indicate Number of CD ROM
Copies of the Proceedings _____
@ US $ 55 each _______ Additional Tickets
Luncheon ____Tickets
@
US $ 25 each _______ Tuesday Evening Reception ____Tickets @
US $ 30 each _______ Wednesday Evening Dinner ____Tickets @
US $ 65 each _______ Total for Additional Items _______ GRAND TOTAL US $ __________ Payment: Check or Credit Card -- Make check payable to the
IMTC. Do NOT send currency. Indicate Credit Card: AMEX
____________ MasterCard
____________ Visa ____________ Credit Card Number
_______________________________________________________ Expiration Date:
_______________ Name as it appears on Card:
_____________________________________________________________________________ Signature:
_______________________________________________________________ Date: _______________________ THE LINE ITEM ON YOUR CREDIT CARD WILL READ:
MYERS/SMITH, INC. Bank Transfer Information: Alliance Bank 100 Corporate Pointe Culver City, CA 90230
USA Phone: 310 410 9281 Account Number: 1050060 Routing Number: 122237997 Please add an additional US $25 to your fee for
processing the transfer and please make sure your name and company are
clearly written on the transfer form.
Attach proof of payment (check or copy of sent order). SEND THIS FORM TO LEE MYERSE-Mail lee.myers@ieee.org
Fax to: +1-310-446-8390 Mail to: IEEE IMTC 2000
c/o Lee Myers 799 North Beverly Glen, Los Angeles, CA, 90077 USA. |