IEEE Vail Colorado Elements Workshop
June 23 – 26, 2002
Registration Form
(Please print or type)
Registration due by June 3, 2002
Name: ______________________________________________________________________________
(Last) (First)
Company: ___________________________________________________________________________
Street Address: _________________________________________________________________
_____________________________________________________________________________
City State Zip Code Country
Office phone: ____________________________ Fax number: ________________________
Home phone: ____________________________ Email address: _______________________
IEEE Membership No. (if any): ______________________ IEEE membership is not required to register.
For prompt confirmation, fax number is required. Confirmation will be faxed or mailed no later than
June 11, 2002.
Registration Fee (per person): Includes workshop registration plus 3 night’s accommodation, and all
meals Sunday night through Wednesday noon.
Single occupancy (IEEE Member) $625.00
Single occupancy (IEEE non-member) $675.00
Companion package (3 nights lodging and reception plus 3 evening meals) $275.00
Companion’s Name: ___________________________________________
Special Needs: ________________________________________________
(Check in US dollars or register by credit card)
To register by credit card (billed by Christiania Lodge)
Card Type: [ ] MasterCard [ ] Visa [ ] American Express
Card Number: _______________________________ Expiration Date: ______________
Signature: _________________________________________________________________
The check should be made payable to Vail Computer Elements Workshop, and sent with your
complete registration form to Dr. John T. Polhemus, IEEE Vail Computer Elements Workshop, 3115
S. York Street, Englewood, Colorado 80110, USA. Mail early or call please, telephone 303-781-6190,
Fax 303-781-9405. P.S. after June 3, 2002 please check with Dr. Polhemus before registering.
Cancellations must be made by June 4 to Dr. Polhemus, then confirmed in writing.