NDSS’04 REGISTRATION FORM 
FAX completed form to: NDSS’04 Registration at +1 703 326 9881. 
MAIL to: NDSS’04 1775 Wiehle Avenue, Suite 102, Reston, VA, 20190, USA 
ON-LINE: http://www.isoc.org/ndss04/ 
After 28 January 2004, registrations will be processed on-site. Please 
note that registrations processed at this point will not be included 
in the initial attendee directory, but will be added to the addendum.

PERSONAL INFORMATION (please print)
 ___Mr. ___Ms. ___Dr. ___Prof. 

First Name:______________________ 

Family/Given Name: ______________________ 

Title: ______________________ 

Organization Name: ______________________ 

Street address: ______________________ 

City: _____________________ 

State/Province: _______	 Postal Code: ______________ 

Country: ______________________ 

E-mail address: ______________________	

Telephone number: ______________________ 

Fax Number:______________________ ___ 

If you are an ISOC member and would like to update your postal 
address with the 
above information, check here. ___ 

Check here if you would not like your name included in the 
“Directory of Registrants”. ___ 

Check if you have special needs: wheelchair access, 
etc. _________________ ___ 

Check if you require special meals: 
__ vegetarian __ kosher _ other (please specify) _____________ 

Symposium Fee 

___ Symposium Fee US$ 695.00
___ Speaker Fee US$ 495.00 
___ Student Fee * US$ 295.00 
* You must provide documentation showing that you are a full time student 
(copy of transcript or letter from your department). 

Tutorial Fee (full-day) US$ 395.00 

TUTORIAL SELECTED: ___ #1 ___ #2 ___ #3 ___ #4 ___ #5 

If registration for a tutorial is insufficient, it may be cancelled. 
Lunch is included for all tutorials. For student tutorial rate, 
contact ndss-reg@isoc.org. 

TOTAL AMOUNT ENCLOSED: $_____________ 

METHOD OF PAYMENT All payments must be in US Dollars. 

___ Check: Make payable to the Internet Society.
___ U.S. Government Purchase Order: P.O. #: __________________ 
Send P.O. with your form.
___ Credit Card: o American Express o Visa o MasterCard 
Name on Credit Card: _________________________________________	
Signature: ____________________________________________ 
Credit Card Number: ___________________________________________	
Expiration Date: ____________________________________ ___ 

Wire Transfer 
Include date of Wire Transfer and Confirmation 
Number ______________ 
Process wire transfers before sending your registration form. 
Include your full name and the letters “NDSS” with wire transfer. 
Please contact the ISOC office for Wire transfer bank 
details.