First name: ______________________________ Middle name(s):
____________________
Family name: ____________________________Title [Prof., Dr., Mr.,
Ms., etc.]: ________
Address (Please write details, make sure that mail can reach you
at the address you provide)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Phone:_____________________ FAX:___________________ E-mail:
_________________
Registration fee
On or Before April 15, 2004 | After April 15, 2004 | |||
US Dollars | CAD Dollars | US Dollars | CAD Dollars | |
IEEE Member | $310 | $410 | $370 | $490 |
Non-member | $390 | $520 | $500 | $670 |
Student | $85 | $110 | $150 | $200 |
PAYMENT: [Check one box: Credit card payment is preferred.]
Fill out this form, sign, and fax to Prof. Ali Sheikholeslami,
Symposium Chair, at
(416) 971-2286. For more information, visit the ISMVL 2004 Website:
http://www.eecg.utoronto.ca/~ali/ismvl2004