REGISTRATION FORM FOR SMP'05 (AND SMI'05)

First cut and paste PART I into an email message, fill in, and email to icss05-registration@deslab.mit.edu

Then, if you wish to pay by check in US $ from a US bank, please print the filled PART I, include a check made to MIT-ICSS, and mail to:

Professor N. M. Patrikalakis

International Convention on Shapes and Solids

MIT Room 5-428

77 Massachusetts Avenue

Cambridge, MA 02139-4307, USA

If you prefer to pay by credit card, please fill also PART II and follow instructions below.

A pdf version of this form is available for your convenience.

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SPM-SMI REGISTRATION: PART I

Title (Mr, Mrs, Ms, Dr, Prof....):

First name (as you wish it on the badge):

Last (family) name:

Affiliation (Company/Lab/University, Department):

Email address:

URL of your home page (if you authorize us to disseminate it):

ACM membership #:

IEEE membership #:

Registration fees (please put a check next to the appropriate fee):

The two costs quoted are: BEFORE / AFTER the May 3, 2005 early registration deadline.

___ SPM only, for a student: $200 / $250

___ SPM only, for an ACM member: $450 / $550

___ SPM only, for a non ACM member: $500 / $600

___ SPM&SMI, for an IEEE or an ACM member student: $375 / $475

___ SPM&SMI, for a non IEEE member and non ACM member student: $425 / $525

___ SPM&SMI, for an ACM member: $800 / $1000

___ SPM&SMI, for a non ACM member and an IEEE member: $850 / $1050

___ SPM&SMI, for a non ACM member and a non IEEE member: $950 / $1175

Conference Dinner on Wednesday
Do you plan to attend the conference dinner: yes ___ , no ___

Number of guests will accompany you at the dinner (additional cost: $50 each): _______.

(Please indicate, for each choice of main course below, the total number of plates for you and your guests:

Main course: chicken _____, salmon _____, vegetarian _____

Total (registration fee plus guest dinners): $___________

Form of payment

Credit card:  VISA ____ or MasterCard____. By fax ___ or mail ___.

Check (in US$ from a US bank): Cashier’s check ___, Company check ____, Money order ____.

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SPM-SMI REGISTRATION: PART II (CREDIT CARD PAYMENT)

For a credit card payment, please fill in and print PART I and PART II and either mail both parts to Dr. Patrikalakis at the address at the top of this form OR fax to +1-617-822-9471, c/o Marge Chryssostomidis, ICSS 05 Convention Manager.

Full name as spelled on credit card: ____________________________________________

Billing address used for the credit card:

Phone number: ______________________

Fax number: _____________________

Credit card number: __________________________

Expiration date: ______________

Signature: ____________________________