2002 IRPS Advanced Registration Form - April 7

2002 IRPS Advanced Registration Form - April 7 - 11, 2002
(Please type, print or attach business card)

name (last, first + initial): __________________________,_________________________

company: ________________________________________mail code: _____________

address: _________________________________________________________

city: ________________ state/country: ___________zip (postal) code: _________
phone: _____________________ fax: _________________________
email: ______________________________________________________________

(__) Check if this is your home address. Company not to be included on mailing label
(__) Please check here if you do not wish to receive mail other than from the Symposium
(__) Please check here if physically challenged and you require any auxiliary aids or services. Please call Scien-Tech Associates, (828) 898-6375
Name for badge of companion (spouse, guest): _______________________________

ADVANCE REGISTRATION FEES* (Before March 22, 2002) and other Fees
*After March 22 and at the door, * marked Symposium fees are $50 and
the Tutorial fees $40 more than the advance rates shown.

IEEE Member (incl. Mem # _____________ ) .. $350.* ____________ Society Membership:(circle one) EDS RS Other ______ NON-IEEE Member ........................... $400.* ____________ Author • Student • Committee • RLM......... $325. ____________ Extra 2002 Proceedings, Qty.___x .......... $ 50. ____________ Extra 2002 Proc CDROM, Qty.___x ........... $ 50. ____________ Basic & Advanced Tutorials (Sun. & Mon.)... $460.* ____________ Basic Tutorials (Sunday) only.............. $260.* ____________ Advanced Tutorials (Monday) only........... $260.* ____________ TOTAL REMITTED ................................. $ ____________

Method of Payment: (check one)

(__) Check: Make checks payable to: IEEE 2002 IRPS
Credit Card (check one): ( )AMEX ( )MASTER CARD ( )VISA ( )Diners Club

Card No.____________________________ Expiration Date:___________

Signature:____________________________________________________

Cancellation fees: $50 after March 22, 2002; Full Fee after March 28. Refunds (minus any cancellation fees) honored by written request up to March 28, 2002.

Send to IRPS Registration; P.O. Box 308; Westmoreland, NY 13490-0308
Or if paying by credit card, fax to 315-336-9134 Questions? reg@irps.org or at 315-339-3968