REGISTRATION FORM ATIS/ITU-T Workshop on NGN
March 19-20, 2006 at The Mandalay Bay, Las Vegas
PLEASE NOTE: THIS REGISTRATION FORM IS FOR NON-ATIS COMMITTEE PARTICIPANTS ONLY
Full Name (as to appear on badge) E-Mail Title Company Address Address 2 City & State Country & Postal Code Phone & Fax Emergency Contact Name & Phone
Workshop Fee: $0.00
Please type or print clearly
March 20-22, 2006 ATIS is offering a special daily rate to ATIS/ITU-T Workshop Participants to attend the ATIS Tech Think. Tech Think Daily Rate: $100.00 (please check each day you plan to attend) __ Monday Payment: __ Check (payable to ATIS) Credit Card No. Verification Code
(required for MasterCard and Visa)
__ Tuesday __ American Express
__ Wednesday __ MasterCard Expiration Date __ Visa
(last 3 digits in the signature box on the back of your credit card)
Authorization Signature
(required to process credit card payment)
Please send this form to: workshop@atis.org or fax to: +1-202-393-5453
ADA Compliance: It is the policy of ATIS to ensure all of its activities are accessible to qualified persons with disabilities in accordance with the Americans with Disabilities Act. If you need special accommodations to fully participate, please be sure to provide a written description and attach it to this form. Cancellation Policy: A registered participant may receive a refund of the fee paid – minus a ten dollar ($10.00) processing fee – if ATIS is notified in writing of the cancellation prior to seven (7) calendar days from the start of the meeting. Address cancellation notifications to: Aivelis Opicka, ATIS, 1200 G Street NW, Suite 500, Washington, D.C., 20005, Fax: +1-202-393-5453, Phone: +1-202-434-8841, e-mail: aopicka@atis.org.