Infocom'96 Registration Form

Rates are quoted in U.S. dollars. Please circle tutorials and registration desired:
Tutorials Before February 23 After February 23
Member Non Member Member Non Member
1. Cox: Wireless Communication $175 $220 $215 $270
2. Zakhor: Image and Video Comp. $175 $220 $215 $270
3. Ramaswami: Optical Networking $325 $405 $390 $485
4. Varaiya: High-Performance ... $325 $405 $390 $485
5. Mitra: Broadband Networking $325 $405 $390 $485
6. Jacobson: Multimedia Conferencing $325 $405 $390 $485
Gigabit Workshop $125 $160 $150 $190
Conference Registration $350 $440 $425 $530
Student Registration $130 N/A $140 N/A
Complete this form and return with check (U.S. dollars) or credit card endorsement payable to:

IEEE Computer Society
Conference Department
1730 Massachusetts Ave., NW
Washington, DC 20036-1992
Phone: +1 202 371 1013
Fax: +1 202 728 0884

Written requests for refunds must be received in the IEEE Computer Society office no later than Friday, March 1, 1996. Refunds are subject to a $50 (U.S. dollars) service charge. Participants with confirmed registration who fail to attend or notify the IEEE Computer Society of cancellation prior to the refund date are subject to the full fee. Substitutions are allowed at any time. Registrations received after Friday, March 8, 1996 will be processed on-site only.

Last Name:
First Name:
(Badge Name):
Company/Organization:
Street Address/Room:
City, State/Zip/Country:
Telephone:
Fax:
Email:
IEEE Membership #:
___ Check Enclosed ___ Purchase Order (Must be attached)

Major credit cards accepted:
___ VISA ___ MasterCard ___ American Express ___ Diners Club
Card Number:
Expiration Date:

Signature

Date:

Name of Card Holder (print):
Do you have any special physical or dietary needs? (Explain):

Do NOT include my mailing address on
___ Non-Society Mailing List ___ Meeting Attendee Lists


Last modified: February 21, 1995
Henning Schulzrinne