MICRO-30 Registration Form

December 1-3, 1995

Research Triangle Park, North Carolina

Name_________________________________________________________________

Name for badge________________________________________________________

Affiliation______________________________________________________________

Address/Mailstop_______________________________________________________

City/State/Zip/Country___________________________________________________

Telephone_____________________________________________________________

Fax___________________________________________________________________

Electronic Mail Address__________________________________________________

X ACM X IEEE Member Number___________________________________________

Registration Fee (see table below) $________________________________________

Please list any special needs or accommodations: ____________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

* Student registration must be accompanied by a photocopy of a valid, full-time student ID; also see the student travel grant program.

Please indicate method of payment:
___ Check drawn on U.S. bank payable to: MICRO-30
___ MasterCard
___ Visa

For card payers:

Name on Card__________________________________________________________

Card No.______________________________________________________________

Expiration Date________________________________________________________

Signature_____________________________________________________________

Today's Date__________________________________________________________

Please send or fax registration form with payment to:

MICRO-30
c/o Manoj Franklin
ECE Department
Clemson University
Riggs Hall
Clemson, SC 29634-0915, USA
Fax: 864-656-5910

This form and other conference information can be accessed via the World Wide Web at http://www.ece.ncsu.edu/micro30

Inquiries may be sent by email to [email protected], but please note that credit card payments may not be made by email since a signature is required.