Docstoc

CONFERENCE REGISTRATION

Document Sample
CONFERENCE REGISTRATION Powered By Docstoc
					                                 CONFERENCE REGISTRATION
                                  International Symposium on Performance Analysis of
                                          Systems and Software – ISPASS-2005
   March 20-22, 2005                               Sponsored by the IEEE Computer
Renaissance Austin Hotel                         Society’s TCI, TCCA, and TCMARCH
     Austin, Texas

            To register ISPASS 2005, please fill out this form (ATTN: Nadeem Malik) and
                           fax it to either +1-512-377-9596 or +1-586-620-6409.
    Last name:_____________________________ First name:_____________________________________
    Name on badge:________________________________________________________________________
    Affiliation:____________________________________________________________________________
    Address:______________________________________________________________________________
          _______________________________________________________________________________
    City:__________________________ State:__________________        Zip code:____________________
    Country:______________________________________________________________________________
    Phone number:____________________________ Fax number:_________________________________
    E-mail:_______________________________________________________________________________
 Please indicate one: ❒ Conference speaker ❒ Co-author ❒ Attendee ❒ Full-time student
 IEEE member? ❒ Yes, membership number:_______________________ ❒ No
                                                                Registration Fee
            Advance Registration
            (until March 11, 2005)            Full Registration
                                                                     ISPASS only   Workshop Only
                                           (ISPASS + Workshop)
     IEEE members                                      $410.00 ❒         $375.00 ❒     $90.00 ❒
     Non-members                                       $525.00 ❒         $470.00 ❒    $110.00 ❒
     IEEE student members / life members               $185.00 ❒         $150.00 ❒     $60.00 ❒
     Full-time student nonmembers                      $225.00 ❒         $190.00 ❒     $75.00 ❒
     IEEE retired members                              $235.00 ❒         $200.00 ❒     $75.00 ❒
                                                                Registration Fee
         Late / On-Site Registration          Full Registration
                                                                     ISPASS only   Workshop Only
                                           (ISPASS + Workshop)
     IEEE members                                      $500.00 ❒         $450.00 ❒    $110.00 ❒
     Non-members                                       $630.00 ❒         $565.00 ❒    $130.00 ❒
     IEEE student members / life members               $230.00 ❒         $180.00 ❒     $75.00 ❒
     Full-time student nonmembers                      $280.00 ❒         $230.00 ❒     $90.00 ❒
     IEEE retired members                              $290.00 ❒         $240.00 ❒     $90.00 ❒
 Additional page charges: _____ extra pages for $100 each = ______________
 Meal preference:       ❒ No dietary restrictions    ❒ Vegetarian            ❒ No Pork/Bacon
 Payment: ❒ Credit card: ❒ Visa         ❒ Mastercard     ❒ American Express       ❒ Diners Club
 Total payment:________ Card number:______________________________Zip Code: ________
 Exp. date:___________ Name on card:______________________ Signature:_______________
           ❒ Check: Mail check (payable to ISPASS-2005) and this form to: Dr. Nadeem Malik,
                 Internal zip 902-2B019, IBM Corporation, 11501 Burnet Rd., Austin, TX 78758, USA
 Signature:______________________________________________________________________

				
DOCUMENT INFO