MPSoC_Registration

MPSOC'05 Forum Registration Form

For registration before May 15th, the fee amounts to 1820 USD for regular attendees, 1560 USD for IEEE members, and 780 USD for students and speakers. Late registration amounts to 2340 USD. It will cover the documentation, the lunch for five days, dinner for three days, and a social dinner for non students. It is necessary to register in advance.

For registration by fax or mail, please send this printer friendly form to:

MPSOC'05
5405 Spine Road Suite 102
Boulder, CO 80301 - USA
Tel: (303) 530-4562 Fax: (303) 530-4334

Family Name: _______________________________________________

First Name: _________________________________________________

Company: __________________________________________________

Address: ____________________________________________________

___________________________________________________________

City: _______________________________________________________

Country: ____________________________________________________

Phone: ______________________________________________________

Fax: ________________________________________________________

E-Mail: _____________________________________________________

ADVANCE REGISTRATION (Postmarked by May 15, 2005)

	Regular attendee	IEEE member	Student	Speaker	Additional Social Dinner
Advance Registration	1820 USD	1560 USD	780 USD	780 USD	130 USD
After May 15	2340 USD	2340 USD	2340 USD	2340 USD	0 USD

Please register me for the MPSoC'05 forum:

[    ] Regular registration fee 1820 USD

[    ] Reduced registration fee for IEEE members 1560 USD
         My IEEE membership Nr is: ___________________

[    ] Reduced registration fee for students 780 USD
         (please join a copy of your student card)

[    ] Reduced registration fee for speakers 780 USD

[    ] Social Dinner for students 130 USD

_______________ TOTAL FEES

Send full payment in U.S. dollars 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 charged a collection fee of US$30.00. Purchase orders are not accepted. Make checks payable to MPSOC'05. For wire transfer fee please add an additional $30.00 to the registration fee. Use your credit card if registering by fax.

check___ credit card ___Visa ___ Mastercard ___ American Express ___

Card # ___________________________________ Exp. date __________

Name (as it appears on card) ____________________________________

Signature _________________________________ Date ______________

REFUNDS: Requests for refunds received before June 15, 2005 will be subjected to a $50 processing fee. No refunds will be made for cancellations received after June 15, 2005 and all registration fees will be forfeited. Register early to avoid disappointment. No registrations will be accepted after June 15.