10Th International Symposium on Medical Information and Communication Technology

10th International Symposium on Medical Information and Communication Technology

March 21-23 2016, Worcester/Boston, MA

This form should be scanned and sent to ISMICT secretary Catherine L. Emmerton at and at the same time copied to ISMICT financial co-chair Allen H. Levesque at by March 14. Please use “ISMICT 2016 registration” as the title of the email. If you prefer to fax the form, you can use+1-508-831-5491.

Personal Information

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Last name First name Middle name

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Organization

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Street Apt. or suite #

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City State ZIP/Postal code

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Country Daytime telephone Fax

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Email (Important information! Your registration confirmation will be emailed to you.)

Conference Registration

A member/non-member registration includes publication expense for one accepted paper, conference welcome reception, keynotes, technical sessions, panel discussions, tutorials, workshops, lunches, coffee breaks, conference souvenir and conference proceeding. In case of multiple accepted papers by one author, one member/non-member registration will cover only one paper. For authors with two or more accepted papers, an additional cost of 200 USD will be charged for each extra paper.

Please check appropriate boxes for registration.

Early Bird (on/before March 7)Late (after March 7)

Member$650Member$725

Non-member$750Non-member$825

*Student member$250*Student member$300

Student non-member$300Student non-member$350

**MIT special event$150**MIT special event$150

Additional accepted paper I$200Additional accepted paper I$200

Additional accepted paper II$200Additional accepted paper II$200

Total Registration Fee Enclosed______

*Student registration is for full-time students only, valid student ID required on the registration day.

**MIT special event includes the participation to the joint technical session at STAMP conference followed by a visit to MIT museum and a buffet.

Electronic Wiring Payment Information

We currently accept payments by wire transfer. The details of the bank account for deposit are shown as follows:

International wiring (USD Only)Domestic wiring

SWIFT Code – NRTHUS33SWIFT Code – N/A

TD Band N.A.TD Band N.A.

370 Main Street370 Main Street

Worcester, MA. 01608Worcester, MA. 01608

ABA Routing Number – 211370545ABA Routing Number – 211370545

Beneficiary Account Number – 8245420306Beneficiary Account Number – 8245420306

Beneficiary Name – Worcester Polytechnic InstituteBeneficiary Name – Worcester Polytechnic Institute

The paper number covered with the payment and conference name "ISMICT 2016" should be put in the remark of the wire transfer. Each registered person with wire transfer needs to provide a scanned copy of the "wire transfer advise" to ISMICT financial co-chair Allen H. Levesque at .