ASIC/SOC'99 Registration Form   (September 15-18, 1999)

Name____________________________________ Organization_____________________________
Dept/Division___________________________________
Address______________________________________
______________________________________________
City__________________ State/Province_________________
Zip/Postal Code_________________________________
Country_________________Telephone_____________________________Fax #__________________________Email_________________________________


Conference Registration:
Full Registration (IEEE Member/Non-Member) includes technical sessions, Thursday evening Banquet, Friday Luncheon, and conference proceedings.
Note for Authors: Each paper should have at least one full registration from one of the authors; student registration will not be counted towards this requirement. If you are an author and this registration counts towards the full registration requirement, please state the paper number and title as in the final program: (example:  FA1.7 or WP1.6):
 
Received before
Received after
Registration
8/16
8/16

IEEE Member
$380 [ ]
$430 [ ]

Non-Member
$430 [ ]
$480 [ ]
Student*
$75  [ ]
$100 [ ]
Addl. Banquet
$45 [ ]
$45 [ ]
Addl. Luncheon
$30 [ ]
$30 [ ]
* ID required, does not include Luncheon and Banquet

Workshop (two half day tutorials; select one workshop for morning and one for afternoon):

IEEE Member
$100 [ ]
$150 [ ]
Non-Member
$150 [ ]
$180 [ ] 
Student**
 $70 [ ]
$70 [ ]

Workshop (one half day tutorial; select the workshop):

IEEE Member
$70 [ ]
$100 [ ]
Non-Member
$100 [ ]
$120 [ ] 
Student**
 $40 [ ]
$40 [ ]
** If space available.

Dietary restrictions if any for Banquet and luncheon:
Vegetarian ______     Other ___________
(accommodation of any or all restrictions cannot be guaranteed)



Extra 1999 Proceedings:
IEEE members ______ @ $45 each US$ _________
Non-members ______ @ $50 each US$ _________
By mail add $5 per order US$ _________
1990-1998 Proceedings
By mail ______ @ $30 each _________
Specify Years __________

Check all that apply
IEEE Member #____________________________
Distinguished speaker____
Presenting Author___ Invited Speaker___
Technical Committee___ Session Chair___
Organizing Committee___ Student___
Workshop Presenter___
This is a corrected/updated address___


Tutorial Workshop Selection
Saturday 9/18)
Morning Workshops: (8 am - 12 noon) Afternoon Workshops: (1:00 pm - 5:00 pm)

Make Check (in US$) payable to: ASIC/SOC Conference
Visa ____
Master Card _____
American Express________
Diners Club __________
Name:_____________________________________
Card #:____________________________________
Expiration Date: ________/________

TOTAL REMITTANCE: US$_______________________

Signature: ____________________________________



Mail Registration Form & Payment:
1999 ASIC/SOC Conference
101 Lakeforest Boulevard, Suite 400-B
Gaithersburg, MD, 20877
Phone: (301) 527-0900
Fax: (301) 527-0994
Email:  wendyw@widerkehr.com

No refunds will be made after 8/31/99.  All requests for refunds must be in writing.  There will be a US$50.00 service charge on all refunds.



For Office Use:
Registration ID Payment Form