This form is available online at:
http://www.icsi.berkeley.edu/waspaa97/regform.html
.
You can also print a slightly prettier version
from the Adobe Acrobat PDF.
Please check one:
Before Aug 19th 1997 | After Aug 19th 1997 | |
IEEE members | ___ $150 | ___ $175 |
Nonmembers | ___ $175 | ___ $200 |
Students | ___ $100 | ___ $125 |
For IEEE members: IEEE Membership number: ______________________________
For students: Institution & program: ___________________________________
Please check one:
___ VISA card. Enter number: ________________________________ Expiry: _________
___ MasterCard. Enter number: ________________________________ Expiry: _________
___ Check drawn on U.S. bank.
SIGNATURE: | _________________________________ |
NAME: | _________________________________ |
ADDRESS: | _________________________________ |
_________________________________ | |
PHONE #: | _________________________________ |
FAX #: | _________________________________ |
EMAIL: | _________________________________ |
Please mail this form, along with your check, to:
For VISA/MasterCard payments, you can also fax the form to: