Please Print
Title: _________ First, MI: ____________________ Last Name: ______________________________
Name for Badge: _____________________________________________________________________
Department: _________________________________________________________________________
Institution: __________________________________________________________________________
Street Address: ______________________________________________________________________
City: ____________________ State: _____________ Zip: ____________ Country: _________________
Phone: _________________ Fax: ___________________ Email: _______________________________
Accompanying Guest's Name: ___________________________________________________________
Mail payment and this form to:
Within U. S. and Canada:
Ray DeCarlo, Registration Co-Coordinator
School of Electrical & Computer Engr.
Purdue University
West Lafayette, IN 47907-1285
phone: 317-494-6389; fax: 317-494-3371
email: ifacreg@ecn.purdue.edu
International:
Ed Kamen, Registration Co-Coordinator
P. O. Box 111
Mableton, GA 30059
USA
phone: 404-894-5823; fax: 404-894-9140
email: ifac96.intl@ee.gatech.edu
Alternatively, you can charge the total amount to: ___Mastercard ___Visa ___American Express
Card No. ___________________________________________________ Exp. Date: ______________
Signature: __________________________________________________________________________
Please circle appropriate amount Full Student* Registration Registration Advance registration fee: US $400.00 US $150.00 (BEFORE APRIL 15, 1996) On-site registration: US $500.00 US $200.00
Full & student registration fees include the Opening Ceremony and Reception, the Closing Ceremony, and Congress Publications as detailed on reverse. Full registration also includes the Congress Dinner.
*STUDENT: I hereby certify that the registrant is a full time student.
Name of Advisor: _______________________ Signature of Advisor: ___________________________
Two volumes included with registration: ______ _______
Additional volumes @ US $18.00 each: ______ _______ ________
On Saturday, June 29, there will be six introductory tutorials. On Sunday, June 30, there will be six advanced tutorials. Full registration cost for tutorials is US$250.00 for one tutorial and US$375.00 for two. Student registration is US$100 for one tutorial; US$200 for two. Please check appropriate box(es) below.
Introductory, Saturday, June 29
Advanced, Sunday, June 30
SOCIAL TOURS
(enter # persons & circle appropriate amt)
Sunday, June 30
Post-Congress Tours