AUTHOR REGISTRATION

IEEE IMTC/2004 CONFERENCE REGISTRATION FORM

Grand Hotel di Como, Como, Italy, 18-20 May 2004

NOTICE: AUTHOR REGISTRATION MUST BE RECEIVED BY 1 MARCH 2004

 

 

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Last (Family) Name                                                                                 First (Given) Name                                                  Middle 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

                                (for Member Discount)

All Fees are in U.S. Dollars               IEEE                        Non-                                                      

Conference Registration                  Member                                Member                                                                                                                Amount

Till 1 March 2004                                US$520                 US$620                                                                                                 _______

Additional Paper Fee**                      US$  50                 US$  50         X  Number of additional papers _______             _______

Member and Non-Member registration includes one copy of the CD-ROM proceedings, entrance to sessions, coffee breaks, 3 lunches, and the Wednesday Evening Banquet.

** 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:

All Fees are in U.S. Dollars                               IEEE                        Non-                       Tutorial                 

Tutorial Registration (each tutorial)              Member                                Member                                                                                               

Till 1 March 2004                                                US$150                 US$180                 1   2   3     (circle the desired ones)                 

From 2 March 2004                                           US$180                 US$215                 4   5   6                                                   _______

Printed Conference Proceedings (only for conference registrants)                        IEEE Member    Non- Member   
Only a limited number will be available from 2 March 2004                                       US$55                   US$65

Number of Copies of the Printed Proceedings  ___________________                                                                                               _______

Additional CD-ROM Conference Proceedings (conference registrants only)        IEEE Member    Non- Member   
Only a limited number will be available from 2 March 2004                                       US$55                   US$65

Number of Copies of the CD-ROM Proceedings  _________________                                                                                                _______

Printed Tutorial Notes                                                                                                       IEEE Member    Non- Member   
Circle the desired ones   1   2   3   4   5   6                                                                     US$30  (each)      US$36  (each)
      _______

Additional Lunch Tickets                                  Number _______Tickets  at             US$30  each                        _______

Additional Wednesday Evening Banquet Tickets       Number _______Tickets  at             US$65  each                        _______

                                                                                                                                                Total Amount    ______________

Payment: Check or money order, bank transfer or credit card. (for bank transfer, please add $25 handling fee to the total amount)

Make check or money order payable to IEEE  IMTC 04. Do NOT send currency.

 

Indicate Credit Card:                           AMEX  ____________                        MasterCard  ____________                 Visa  ____________

 

Credit Card Number ______________________________________________________________ EXP. DATE: _________ ______

 

Name of the Card Holder as it appears on Card: __________________________________________________________________

 

Signature: __________________________________________________________________  Date: ________________________

 

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

Send this registration form by ONLY ONE of the following ways:

E-Mail:    lee.myers@ieee.org                                           or Fax:   +1-310-446-8390

or Mail: IEEE  IMTC 2004  c/o Lee Myers 799 North Beverly Glen, Los Angeles, CA, 90077 USA.