PSDW Fall 2004 Pre-Registration Form

You MUST fill out this form to reserve a seat at the workshop, to reserve a free lunch seat, to reserve a copy of the workshop proceedings, and to receive email updates about the workshop and upcoming events. If you experience any technical problems submitting this form, please contact the workshop organizer northjerseysac AT ieee DOT org.

This form collects information to gather statistics on the audience who is interested in attending this workshop. It is also used to get a head-count for seating, ordering food, printing, etc. The information in this form will in NO WAY be made public to anyone outside of the organizers of this workshop. It is used primarily to communicate new information to the audience and keep them informed of events happening in the region.

Fields in BOLD are required for pre-registration to PSDW Fall2004.

First Name: Last Name:

University/College name:

Current Year: Graduating in year:

Email Address:

Street Address Line1:

Street Address Line2:

City: State: ZipCode:

Phone # (abc-def-ghij):

Are you an IEEE Student Member/IEEE Member ? YES NO

If you are an IEEE (student) member, enter your membership number here:

I will have lunch and refreshments at PSDW Fall 2004 (all FREE): YES NO

Special food restrictions ? Vegetarian ? YES NO

Comments, questions, suggestions ?? Please include them below.

Mailing List Info

If you would like to subscribe to the North Jersey Section Student Acitivities Mailing List to get regular email about this and other events like it in the greater NY-NJ Metro Area. Subscribe NOW. (Note: This is a low volume email list that distributes information one way and is used only for IEEE related business, addresses are not given out to anyone.)

If you have any troubles with the registration form, just email the organizer, northjerseysac AT ieee DOT org to register directly.