Registration Form for ME-96

Method Engineering '96 Registration Form
Last Name
First Name
Male/Female
Organization
Department
Address
City
State
Postal Code
Country
Telephone
Fax
Email (important!)

Registration submitted	by August 10	after August 10	Amount paid
Conference	USD 295	USD 345	__________
Monday outing	# extra persons___	times USD 10	__________
Conference Dinner	# extra persons___	times USD 45	__________
Total Amount			__________

Special Needs NB: We will attempt to accommodate your dietary needs. The Monday evening event will, however be a BBQ, and may not be appropriate for those who are vegetarians or have other dietary restrictions.
Method of Payment (indicate below)
Commercial check __	Commercial (institutional) check drawn on a bank with clearing operations in the USA and payable (without charges) in USD
Wire transfer ___	Payment order (or wire-transfer) Remit to the Nations Bank, Georgia State University Operating Account Number: 0000008648. The AVA (Routing) number is 061000052. Thepayment order should reference the registrant's full name and indicate that this is for IFIP ME-96. Please attach a copy of the receipt to the registration form.
Banker's draft ___	Banker's draft, net of bank charges. Enclose draft payable to Georgia State University stating IFIP ME-96 and full name of the participant.
Personal check ___	Personal check ... N.B.: Personal checks cannot be accepted against banks located outside the United States or Canada. Checks originating against a Canadian bank should either be denominated in USD or use the prevailing "buy CAN$ rate" of an American bank. Please do this (CAN$ check) only if the other options are unavailable to you as it will cost us a lot of time and some money to handle this.
Credit Card:	VISA ____	MasterCard ___	American Express ___
Card Number:
Expiration Date	Month ___	Day ___	Year ___
Total in US$	US$ _____________
Place of writing:	_________________	Date of authorization:	____/_____/_____
Signature
Payment (or payment evidence) must accompany the registration form. A 25% cancellation fee until August 10, 1996, no refund thereafter.

Please return at your earliest convenience to:

Ms. Carol Carter
Department of Computer Information Systems
Georgia State University
PO Box 4015
Atlanta, GA 30302-4015
USA

Fax: +1.404.651.3842
E-mail: ccarter@gsu.edu

If sending by courier (FedEx, UPS, etc.), you'll need to use the street address for delivery:
Ms. Carol Carter
Department of Computer Information Systems
Georgia State University
35 Broad Street
Room 931
Atlanta, GA 30303
USA

This address should only be used for delivery services.