Registrant Information * Indicates required fields

*Last/Family/Surname*First/Given Name

*Organization

* Address (Line 1) Address (Line 2)

*CityUS State/Canadian Province*Postal/Zip Code*Country/Region

Primary Contact NumberFax Number*Email (required for confirmation purposes)

Emergency ContactEmergency Contact NumberIEEE Membership number

How did you hear about this event? / What is your main reason for attending? / Is this your first time attending?
Email / Attending Sessions / Yes
Website / Presenting / No
Colleague / Session Chair
Call for Papers / Research & Development
Other______/ Networking

What professional societies do you belong to?______

If you have a disability and may require special accommodations in order to fully participate, please check the box below. You will be contacted by someone from our staff to discuss your specific needs.

Please check the box if you have any special needs.

Please indicate your special need ______

Please indicate your dietary restrictions ______

(ie. Lactose Intolerance, Allergies, Religious/Cultural Traditions).

ASTR Conference Registration Fees / On/Before Sep. 15 / After Sep. 15
IEEE Member / US$750 / US$850
Non Member / US$950 / US$1050
Student Member / US$250 / US$250
Student Non-Member / US$250 / US$250
Presenter / US$550 / US$550
ASTR Committee Member / US$550 / US$550
Exhibitor / US$1700 / US$1700

Registration Includes: Exhibitor Reception, Meals (Breakfast & Lunch each day), Conference Banquet and Proceedings CD

*Note: Exhibitor Registration will include 2 attendees and each attendee will receive the items included with registration listed above.

Additional Items

Qty ______Additional Conference Banquet (US $100)

Qty ______Additional Proceedings (US $75)

Registration / Additional Items / TOTAL
$______ / + / $______ / = / $______

Cancellation Policy

All refund/cancellation requests must be provided in writing and received by 15 September 2012. There will be an administrative fee of US$25 deducted from each refund. No refunds will be issued after 15 September 2012. Please submit all cancellation/refund requests to .

Method of Payment: Check- Please make payable to: IEEE ASTR Conference

Please attach a copy of the wire transfer receipt with registration form. Please email for Wire transfer instructions.

Credit Card:Visa MasterCard American Express Discover

Card Number ______CVC code______Exp.Date______

Name on Card______Authorized Signature ______

IEEE may contact you regarding similar IEEE conferences, services and/or technical products. If you prefer not to be contacted please select NO.

Email/Mail/Fax Completed Registration Form & Fees To: (Please do not submit this form without payment)

IEEE/MCM: Shana Ramani, Registrar, 445 Hoes Lane, Piscataway, New Jersey 08854-4141 USA

Tel: +1 732 465 7810 Toll Free (in US or Canada): + 1 800 810 4333 Fax: +1 732 465 6447 E-mail:

Non‐discrimination: "IEEE is committed to the principle that all persons shall have equal access to programs, facilities, services, and employment without regard to personal characteristics not related to ability, performance, or qualifications as determined by IEEE policy and/or applicable laws. For more information on the IEEE policy visit