ATTENDEE REGISTRATION
IEEE IMTC/2004 CONFERENCE REGISTRATION FORM
Grand Hotel di Como, Como, Italy, 18-20 May 2004
NOTICE: ADVANCE REGISTRATION CONTINUES UNTIL 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-		Student	and	
Conference Registration		Member		Member		Life Member				Amount
Till 1 March 2004		US$520		US$620		US$125				
From 2 March 2004	 	US$575		US$675		US$150					_______
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.
Student and IEEE Life Member registration includes one copy of the CD-ROM proceedings, entrance to sessions, coffee breaks, 3 lunches.   Students must include copy of the IEEE student member or university identification card.
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 Mail: 		IEEE  IMTC 2004  c/o Lee Myers 799 North Beverly Glen, Los Angeles, CA, 90077 USA.  
or Fax: 		+1-310-446-8390