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

_________________________________________________________________________________________________________ 
Last (Family) Name						First (Given) Name				Middle Name (initial)

_________________________________________________________________________________________________________ 
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.