IEEE/PES Insulated Conductors Committee
Spring 2005 Meeting Registration Form
Last Name: ______/ First Name: ______/ Middle Initial:______First Name for Badge:______/ Guest Name Badge First: ______/ Last: ______
Company:______
Address: ______
______
City: ______/ State/Province:______/ Postal Code: ______/ Country: ______
Phone No: ______/ Fax No: ______/ Email: ______
IEEE Member: / Yes: ___ / No: ___ / Member No.* ______/ IEEE-SA Member: / Yes: _____ / No: _____
PES Member: / Yes: ___ / No: ___ / Section Name ______
ICC Member Classification:** / Guest: ___ / Member: ___ / Voting Member: ___ / Corresponding Member:____
Membership in IEC or other Organization (please specify): ______
* If you do not provide your IEEE member number, you will pay the non-member rate.
** Procedures for requesting a change in classification are on the ICC website.
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Code / Number / Each / Line Total US $- MEETING REGISTRATION - /
Advance Registration & Minutes: IEEE Member /
ARM
/ ______/ @ $165.00 US / ______Advance Registration & Minutes: Non-IEEE Member / ARN / ______/ @ $175.00 US / ______
On-Site Registration & Minutes: IEEE Member / ORM / ______/ @ $185.00 US / ______
On-Site Registration & Minutes: Non-IEEE Member / ORN / ______/ @ $195.00 US / ______
Complimentary Registration1 / CR / ______/ No charge / ______
Guest/Companion Registration2 / GR / ______/ @ $20.00 / ______
Spring 05 Minutes3
Table Top Display / SM
TT / ______
______/ @ $50.00
@$350.00 / ______
______
1 Note: Complimentary registration for students, press, and retired (not working). Minutes are not included.
2 Note: Please register the number of spouses/guests/companions so we can properly plan.
3Note: The ICC Minutes are now included in the registration fee. Use this block to order extra minutes or if you are a corresponding member. Spring Minutes will be mailed out after the meeting. Previous minutes can be obtained from JMed & Associates, Ltd., E-mail: , Phone: (847) 934-1154.
- EVENT REGISTRATION -April 17 Orientation Program / ONP / ______/ No charge / ______
April 17 Reception / REC / ______/ No charge / ______
April 19 Transnational Lunch /
TL
/ ______/ @ $35.00 US / ______April 20 Educational Program Lunch / EDL / ______/ @ $30.00 US / ______
April 20 Educational Program / EDP / ______/ No charge / ______
April 20 PDH Certificate / CER / ______/ No charge / ______
- COMPANION ACTIVITY -
April 18 Monday Activity-check web for details / ACT1 / ______/ @ $35.00 / ______
April 19 Tuesday Activity–check web for details / ACT2 / ______/ @ $20.00 / ______
Total Amount Enclosed: / $US Funds Only: / ______