A single-page version of this registration form is also available.

Name: ________________________________________________________

(First) (Middle) (Last)

Affiliation: ________________________________________________________

Address: ________________________________________________________

City: ______________________ State: ____________________

Zip Code: ______________________ Country: _________________

Phone: ______________________ Fax: _____________________

Email: _________________________________________________

Are you a Member of IEEE/Computer Society? Yes #_____________

Conference Registration EDP# 012Q91:

Advance Registration (by October 10, 2001): Late/On-Site Registration:

IEEE Member $500.00 __________ IEEE Member $600.00 __________

Non-Member $625.00 __________ Non-Member $725.00 __________

Student $150.00 __________ Student $175.00 __________

Extra Reception $50.00 __________ Extra Reception $50.00 __________

Total Amount Due: __________ Total Amount Due: __________

The registration fee includes admission to technical sessions, a copy of the proceedings, a reception at the Riverside Citrus State Park (November 12, 2001) (additional tickets for reception $50.00), lunch (November 13, 2001), and morning/afternoon breaks in on all three days.

Tutorials EDP#012Q92:

Advance Registration (by October 10, 2001): Late/On-Site Registration:

IEEE Member $250.00 __________ IEEE Member $300.00 __________

Non-Member $320.00 __________ Non-Member $375.00 __________

Student $200.00 __________ Student $250.00 __________

Total Amount Due: __________ Total Amount Due: __________

The tutorial fee includes a copy of the tutorial notes, breakfast, lunch, and morning/afternoon breaks. There are two tracks: Track-1 (1 full-day tutorial), Track-2 (2 half-day tutorials).

I will be attending the _____ FULL-DAY Tutorial, or ______ the two HALF-DAY Tutorials (please check at most one).

Food Restrictions: Vegetarian/Diet ( ) ____________

Method of Payment: Amount to be charged: _____________

(Sum of conference registration fee, additional reception tickets, and tutorial registration fee)

NOTE: Payment can be made by Credit Card, Check or Money Order to the address listed below. For credit card payments, a copy of this form, with information and signature may be faxed/mailed to the following information below. Checks or money orders can be sent to the address listed below.

1. Credit Card: # __________________________________________

(Visa and Master Card Only)

Expiration: ________

Signature: (Required for Credit Card)______________________________

Name: _______________________________________________

2. Check or Money Order: Payable to: UC Regents (In USA Dollars)

Address for Mailing:

Les J. Cromwell, Manager, Conference & Instructional Support Services

Attention: ICNP Conference 2001

University of California, Riverside

1200 University Avenue

Riverside, CA 92507-4596

Email: Lcromwell@ucx.ucr.edu

Fax: (909) 787-7273

Telephone: (909) 787-4105 Ext. 1075

Cancellation Policy: Full refund, less $100.00 for administrative fees, before 10/10/01; no refund after this date.