Phone No. ___________________
Fax No: ____________________
E-Mail ID: _____________________________
Affiliation: ____________________________________________________________________
IEEE Member [ ] Yes [ ] No Member No: ___________________
PES Member [ ] Yes [ ] No Chapter Name: ______________________________
ICC Member Classification [ ] Guest [ ] Member [ ] Voting Member
Note: To request a change in your membership classification see the ICC membership guidelines.
IEC or other International Organization (please specify): __________________________
| Number | Each | Total US $ | ||
| Advance Registration: | IEEE Member | ARM | ___ @ 60.00 | _______ |
| Non-member | ARN | ___ @ 70.00 | _______ | |
| On-site Registration: | IEEE Member | ORM | ___ @ 70.00 | _______ |
| Non-member | ORN | ___ @ 80.00 | _______ | |
| Complimentary Registration | (retired) | CR | ___ @ n/c | |
| ICC Minutes, Fall 1996 - St. Pete | (if available) | FM | ___ @ 30.00 | _______ |
| ICC Minutes, Spring 1997 - Scottsdale | SM | ___ @ 30.00 | _______ | |
| April 20 - Orientation Program | ONP | ___ @ n/c | ||
| April 20 - Reception | REC | ___ @ n/c | ||
| April 21 - Transnational Lunch | TL | ___ @ 25.00 | _______ | |
| April 22 - Award Lunch | AL | ___ @ 25.00 | _______ | |
| April 21 - Valley of Sun Tour | VST | ___ @ 35.00 | _______ | |
| April 22 - Heard and Art Museums Tour | HMT | ___ @ 25.00 | _______ | |
| Total Amount Enclosed U.S. $ | _______ |
Please make checks payable in US funds to "ICC", and return this from with your payment by April 11, 1997 to the Vice Chairman:
R. A. Hartlein
Georgia Tech NEETRAC
62 Lake Mirror Road - Building 3
Forest Park, GA 30050
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