
Company _____________________________ Mail Stop ___________________________
Street Address ___________________________________ City ____________________
State __________________ Zip Code ___________ Country ______________________
Tel: ________________________________ Fax: _________________________________
E-mail: _________________________________ IEEE Member No.: _________________
Dietary Requirement: Vegetarian ___ Other _________________________________
ADVANCE REGISTRATION
IEEE Member
IEEE Student Member Non-Member
$295
$150
$395
LATE REGISTRATION
(After October 10, 1997)
IEEE Member
IEEE Student Member Non-Member
$395
$200
$495
Total Fees ___________
SEND FULL PAYMENT in US$ WITH THIS FORM. USE A CHECK DRAWN ON A
US BANK OR
A MAJOR CREDIT CARD. FOR PAYMENTS FROM NON-U.S. BANKS THE ATTENDEE WILL BE
BE CHARGED A COLLECTION FEE OF $30.00. PURCHASE ORDERS ARE NOT ACCEPTED.
MAKE CHECKS
PAYABLE
TO 1997 IEEE HIGH LEVEL DESIGN VALIDATION & TEST WORKSHOP.
USE YOUR CREDIT
CARD IF REGISTERING BY FAX.
Check ___
Credit Card ___ Visa ___ Mastercard ___ American Express ___
Card No. _______________________________ Exp. Date _____________
Name (as it appears on card) ____________________________________
Signature _______________________________________________________
Refunds: Requests for refunds received before October 10, 1997 will
be subject
to a $50 processing fee. No refunds will be made for cancellations
received
after October 10, 1997,all registration fees will be forfeited.
Attendance is limited. Register early to avoid disappointment.
First Name _______________________ Last Name ___________________________
Company _____________________________ Mail Stop ___________________________
Street Address ___________________________________ City ____________________
State __________________ Zip Code ___________ Country ______________________
Tel: ________________________________ Fax: _________________________________
Check Accommodations Desired
Single @ $140 ____ Double @
$140 ____
Rates are per day in US$. Add 11% tax.
Arrival Date _____________ Departure Date ______________
Your reservation can be guaranteed by credit card. Your credit card
will be
billed for first nights deposit.
Credit Card ___ Visa ___ Mastercard ___ American Express ___
Card No. _______________________________ Exp. Date ____________
Name (as it appears on card) ___________________________________
Signature _____________________________
Cancellations must be received at least 24 hours prior to arrival.