20 – 22 April
Baltimore, Maryland USA
Registrant(s) Information *Are required fields & must be completed.
*Last/Family/Surname*First/Given Name
*Organization
*Address(line 1) *Address (line2)
*CityUS. State/Canadian Province*Postal Code/Zip*Country/Region
*Main Phone Number*Main Fax Number
*Email AddressTo receive confirmation, please enter a valid email address.CC:Email If an above email is entered the above recipient will receive a copy of your confirmation letter.
I ama IEEE Society Member: (check all that apply) ? DEIS ? IAS ? OES ? PELS ? PES ? VTS ? Sensors Council ? Systems Council ? NTDC
Please fill in other technical Society memberships related to ESTS. Please List: ______
Registration Categories Early Advanced Late
Before 1-March After1-March After 1-April/Onsite
IEEE Member US$400US$450 US$500
Non Member US$400US$450 US$500
Life Member US$225US$275 US$300
*Student US$225US$275 US$300
*Students registration requires proof of current enrollment – Full time
Fax a copy of your student ID to +1 732 465 6447 Attn: Diana Krynski
Registration Fee Total US$______
Registration fee includes:Conference Reception on Monday, Banquet on Tuesday, Breakfast, and Lunch on Tuesday/Wednesday, and one copy of a CD-ROM of the proceedings.
IEEE Member? Yes No / Member Associate Life Student - IEEE Number:______Are you an author? Yes No / Authors are required to register by 22February 2009.
If you are presenting a paper, please list your four-digit Paper ID number here. This information will help to determine which authors’ are/not registered.
Authors, please list paper ID: ______
Do you require Special Access? Yes No / Special Access Details: ______
Do you have Dietary Restrictions? Yes No / Dietary Restriction Details:______
Emergency Contact Information / Emergency Contact:______
Emergency Telephone:______
Yes No Note: IEEE may use the information you provide to contact you from time to time concerning similar IEEE conferences, technical products and/or services, or to ask your opinions. If you do not want us to contact you, please select “No.”
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2009 ESTS
20 – 22 April
Baltimore, Maryland
Attendee(s) Name______
CONFERENCE MEALS:
To help us with meal planning, please indicate which meals you plan to attend. Your selections here are not binding – you are welcome to all events.
Monday, 20 April:
Reception: Yes, I plan to attend. No, I do not plan to attend. Maybe
Tuesday 21 April:
Breakfast: Yes, I plan to attend. No, I do not plan to attend. Maybe
Lunch: Yes, I plan to attend. No, I do not plan to attend. Maybe
Banquet: Yes, I plan to attend. No, I do not plan to attend. Maybe
Wednesday 22 April:
Breakfast: Yes, I plan to attend. No, I do not plan to attend. Maybe
Lunch: Yes, I plan to attend. No, I do not plan to attend. Maybe
______
Additional Items:
Banquet Tuesday 21 April #______@US$60 = US$______
Extra CD-ROM of Proceedings #______@US$75 = US$______
Additional OptionTotal US$______
Total Remittance US$______
Visa Assistance Letters
Speakers, Committee members and paid attendees requiring visa assistance letters must send an email to
Noel
Cancellation Policy:Registration fees are nonrefundable after 15 March 2009. There is a US$50 service fee on all cancellations prior to 15 March 2009.
Method of Payment:
(please note this conference does not acceptwire transfer payments)
CHECK (Payable to: 2009 ESTS)
Purchase Order
VisaMasterCard American Express Discover
Card Number______Exp Date ______
Name on Card______Authorized Signature ______
IEEE-MCM Diana Krynski, Registrar
445 Hoes Lane, Piscataway, New Jersey 08854 USA
USA & Canada +1 800 810 4333 International +1 732 465 7810
Fax: +1 732 465 6447
E-mail:
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