2002 IRPS Advanced (Door rate-past deadline) Registration Form - April 7

2002 IRPS Advanced (Door rate-past deadline) Registration Form - April 7 - 11, 2002
(Please type, print or attach business card)
NOTE: After March 29 just bring to door. The IRPS registration office in Rome, NY is closed after March 29
while transiting to the Hyatt Regency Dallas where Door Registration opens on Saturday evening 6 to 9 p.m., April 6

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): _______________________________

REGISTRATION (Door rates) FEES (After March 22, 2002) and other Fees

IEEE Member (incl. Mem # _____________ ) .. $400.* ____________ Society Membership:(circle one) EDS RS Other ______ NON-IEEE Member ........................... $450.* ____________ Author • Student • Committee • RLM......... $325. ____________ Extra 2002 Proceedings, Qty.___x .......... $ 50. ____________ Extra 2002 Proc CDROM, Qty.___x ........... $ 50. ____________ Basic & Advanced Tutorials (Sun. & Mon.)... $500. ____________ Basic Tutorials (Sunday) only.............. $300. ____________ Advanced Tutorials (Monday) only........... $300. ____________ 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.

If paying by check bring form and check to door. Do not mail after March 22.
Or if paying by credit card, fax to 315-336-9134 before March 30th Questions? reg@irps.org or at 315-339-3968