NDSS'98 REGISTRATION FORM

Pre-registration is now closed.
You may register on-site beginning 11 March 7:30 am.

Complete this form and FAX it to NDSS'98 Registration at +1 703 648 9887 or mail it to NDSS'98, 12020 Sunrise Valley Drive, Suite 210, Reston, VA, 20191, USA.

PERSONAL INFORMATION
__Mr __Ms __Dr __Prof __Dip Ing __Ing __Mlle

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First Name: MI: Family/Given Name: Sr__Jr __II __III

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Badge Name:


Please enter your name as you would like it to appear on your name tag.

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Business Title: Organization Name:

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Street Address:

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City: State/Province: Postal Code:

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Country: E-mail address:

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Telephone Number: Fax Number:

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___ Check here if you have special needs: vegetarian meals, wheelchair access, etc.
___ Check here if you would NOT like your name included in the list of registrants.

PAYMENT INFORMATION
All payments must be in United States Dollars.

If you are an Internet Society member, you are eligible for a reduced conference registration fee. Non-member symposium attendees will receive a one year Internet Society membership as part of the non-member registration fees.

Symposium FeeOn/Before February 13After February 13
 
___ Internet Society Member FeeUS$ 375.00US$ 445.00
___ Non-Member FeeUS$ 425.00US$ 495.00
 
Tutorial Fee (half-day)US$ 125.00 (each)US$ 160.00 (each)
Special Discount:US$ 195.00 (two)US$ 245.00 (two)
Register for two half-day tutorials and receive a special discount.
___ #1 (Part I) ___ #1 (Part II) ___ #2 ___ #4 ___ #5
TOTAL AMOUNT
ENCLOSED $_______

METHOD OF PAYMENT
Payment must be received by March 3, 1998. After March 3, attendees must register on-site.

___ Check Make payable to the Internet Society.

___ U.S. Government Purchase Order P.O. #: ________________
Fax or mail a copy of your purchase order along with your registration form.

___ Credit Card (circle one) American Express VISA MasterCard

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Name on Credit Card:

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Credit Card Number: Expiration Date:

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Signature:

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___ CyberCash Account #: _______________________

___ Wire Transfer* Wire Transfer Confirmation Number: _____________________
Process wire transfer before sending registration form.
* Include your full name & NDSS with the wire transfer.
Bank ABA Number: 054000030Riggs National Bank, N.A.
Account Number: Internet Society 148 387 10950 Herndon Parkway, Herndon, VA 20171 USA

CANCELLATION POLICY
Refunds (less a $25 processing fee) will be issued for cancellations received on/before March 3, 1998. No refunds can be issued after March 3,1998.