ATTENDEE REGISTRATION
IEEE TUTORIALS 
Fairmont Chateau Laurier Hotel, Ottawa, ON, Canada, 16 May, 2005

_____________________________________________________________________________________________ 
Last Name					First Name				Initial
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Organization						 Street Address
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City			State/ Province 			Country			Postal Code
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Phone Number			Fax		 	E-mail Address 		IEEE Member Number

Fees in U.S. Dollars 	Tutorial T1 ($150) _____	Tutorial T2 ($150) _____	Tutorial T3 ($150) _____

									Total Amount $________

Payment: Check or Money, Bank Transfer or Credit Card.
Make check or money order payable to the IEEE I&M Society. Do NOT send currency.
Indicate Credit Card: AMEX ____________	MasterCard ____________  Visa ____________
Credit Card Number _________________________________________________ EXP. DATE: _________ 

Name as it appears on Card: ______________________________________________________________

Signature: ________________________________________________ Date: ________________________
THE LINE ITEM ON YOUR CREDIT CARD WILL READ: MYERS/SMITH, INC.

E-Mail Form to:	lee.myers@ieee.org
Or Fax to: 		_1-310-446-8390