ADVANCE CONFERENCE REGISTRATION FORM

45thASILOMAR CONFERENCE ON SIGNALS, SYSTEMS AND COMPUTERS

November 06 – 09, 2011

PLEASE FILL IN FIELDS or PRINT CLEARLY(information will be used to send CD Proceedings) * Required fields & must be completed

Last Name*: / First Name*: / MI:
Company/University or other Affiliation*:
Mailing Addr*:
P.O. Box/Mail Stop*:
City*: / State/Province*:
ZIP/Postal Code*: / Country*:
Bus. Phone*: / Cell Phone: / Fax:
E:mail*

Dates on site (check what applies): Sunday; Monday;Tuesday; Wednesday

Important - Please read notes at the end of the registration form

Avoid mailing - Register online instead at

CONFERENCE REGISTRATION FEES4

/ Advance rate postmarked by Oct. 1 / On-site rate /
Postmarked after Oct. 1 / Total
General ParticipantsRegistration Fee1,5 / $400.00 / $500.00
StudentsIEEE Life memberRegistration Fee1,5 / $250.00 / $350.00
Additional CD-ROM / $35.00/each Quantity:
Discounted lunch meal ticket for Wednesday lunch5 / $8.00/meal
Check box if you wish to purchase, and add price to total
TOTAL PAYMENT2 / ($USD)

Method of Payment (Note:Purchase orders are NOT accepted) – Registration forms received without payment are NOT accepted

Check
Cash (on-site only)
Money Order
Bank Draft
Traveler’s Check
Made checks payable to the order of: SS&C Conference Corporation / Credit Card (only VISA or MasterCard accepted) VISA; MC
Credit Card number:
Expiration Date:
Cardholder’s name:
Cardholder’s signature:
Mailing Address:
Asilomar Conference on Signals, Systems and Computers
P.O. Box 8236
Monterey, CA 93943-8236, USA / Faxed Registrations:
Will be accepted with credit card payment only
Fax: (831) 373-8082 / For questions regarding conference registration,
contact: Ms. Sue Netzorg, Conference Registrar
ph:(831) 915-4691

Note: the Hotel Registration form MUST BE MAILED SEPARATELY to the AsilomarConferenceCenter. All hotel related questions must be directed to the AsilomarConferenceCenter directly. See Hotel registration form for further details.

Important Notes – Please read carefully

1)One CD-ROM is included in the conference registration fee; Student/IEEE Life member registrations must attach a proof of current student/IEEE Life membership status to this registration form.

2)Please remit in U.S. Dollars (NO PURCHASE ORDERS ACCEPTED). Only checks drawn on US banks will be accepted. You may use a credit card, US bank drafts, money orders or traveler's checks, cash accepted for on-site registrations only.

3)Registration fees refunded only when written cancellation notification is received NLT Oct. 20 subject to a $50.00 cancellation fee.

4)For registrations RECEIVED by October 23: Registration fee for attendees includes lunch at Asilomar on Monday and Tuesday for attendees not staying at the Conference Grounds (one meal ticket/day will be handed out at registration – lost tickets will not be replaced).For registrations received after October 23: a limited number of lunch tickets will be available and handed out on a first-come first-serve basis.

5)For registrations RECEIVED by October 23:Wednesday lunch tickets must be purchased separately for attendees not staying on grounds the Tuesday night (11/08/11). You may purchase discounted meal tickets with your advance registration.For registrations received after October 23: a limited number of full price lunch tickets will be available and sold on a first-come first-serve basis.