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1999 International Analog VLSI Workshop
WORKSHOP REGISTRATION FORM


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Early Registration Deadline: April 2, 1999
Late Registration Deadline: April 16, 1999
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>>>>> Send the WORKSHOP REGISTRATION FORM to:

Attn: Ms. May Song
Chip Implementation Center
5, Technology Road III, Science-Based Industrial Park,
Hsinchu, Taiwan, R. O. C.
Tel: +886-3-5773693 ext. 126
Fax: +886-3-5774064
E-mail: may@mbox.cic.edu.tw

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

I. Tutorial Registration Fee
 ( The tutorial registration fee includes the classnote and lunch on May 5.
The Full-time student must provide the photocopy of the Student ID or Certificate. )

Early:
1. IEEE or IEEJ Member             US$ 80 ____   (NT$ 2,500 ____)
2. Non-Member                      US$ 96 ____   (NT$ 3,000 ____)
3. Full-time Student               US$ 40 ____   (NT$ 1,200 ____)


Late/On-Site:  
1. IEEE or IEEJ Member             US$ 100 ____  (NT$ 3,200 ____)
2. Non-Member                      US$ 120 ____  (NT$ 3,800 ____)
3. Full-time Student               US$ 50 ____   (NT$ 1,500 ____)

II. Workshop Registration Fee
(Except the fee for Full-time Student, the workshop registration fee includes 
the proceeding, lunches  and banquet. The student registration fee includes 
the proceeding and lunches. An additional banquet ticket is available with charge. 
The Full-time student must provide the photocopy of the Student ID or Certificate. )

Early:
1. IEEE or IEEJ Member             US$ 200 ____   (NT$ 6,500 ____)
2. Non-Member                      US$ 240 ____   (NT$ 7,800 ____)
3. Full-time Student               US$ 80 ____    (NT$ 2,500 ____)
4. Banquet                         US$ 50 ____    (NT$ 1,500 ____)

Late/On-Site:  
1. IEEE or IEEJ Member             US$ 250 ____  (NT$ 8,100 ____)
2. Non-Member                      US$ 300 ____  (NT$ 9,800 ____)
3. Full-time Student               US$ 100 ____  (NT$ 3,200 ____)
4. Banquet                         US$ 50 ____   (NT$ 1,500 ____)

III. Special Meal Requests (e.g.,vegetarian) :________________________

IV. Method of Payment 

Total Payment: US$ ________________  (NT$ ________________)

1. Check ___ (Only checks in US Dollars drawn on a US Bank will be accepted; 
please make check payable to : IEEE Taipei Section. 
For Taiwan attendees, NT Dollars checks are also acceptable; please make check 
payable to: ��y��������󋛇�Ō����w�`�肾��)

2. Credit Card ___

Visa__       MasterCard__     Japan Credit Bureau__

Card Number: _________________________   Exp.Date: ____________


Card Holder Signature: _________________________________________________

V. Cancellations will be honored by April 23 with a US$50 processing fee.
   NO REFUNDS AFTER APRIL 23.

VI. Contact Details:

Name:  Last Name______________ First Name______________ Middle Name______________

Affiliation: _____________________________

Address: __________________________________________________________

City _____________State ______________Zip ____________Country ____________

Phone: _________________________________ Fax: ________________________________

Email: _______________________________________________

IEEE or IEEJ NO.: ________________________


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