SIGCSE/SAC97 REGISTRATION FORM

Please print all requested information clearly.

Full Name___________________________________________________________________________________

Name as you would like it on your badge___________________________________________________________

Company or school____________________________________________________________________________

Address_____________________________________________________________________________________

City________________________ State/Province______________________ Zip/Postal Code________________

Country ____________________________________ Daytime phone number_____________________________

Home phone number _________________________________ Fax______________________________________

E-mail _____________________________________________________ Membership number________________

Special services required ______________________________________________________________________

Check here if you do not want your name included on attendee lists made available to outside organizations.

Conference Registration
(Circle appropriate registration fee.)
Member
Nonmember
Student
Early registration must be postmarked by 1/31/97 EarlyLate EarlyLate MemberNonmember
SIGCSE Technical Symposium (SIGCSE) $115$130 $165$180 $20$30
Symposium on Applied Computing (SAC) $245$270 $300$325 N/AN/A
Joint SIGCSE/SAC$340 $380$445 $485N/A N/A
Exhibits only$25 $25$25 $25N/A N/A

SIGCSE Workshops & SAC Tutorials

(Circle those you want to attend and appropriate
registration fee. Fee is per workshop.)

Member
Nonmember
Student
Early registration must be postmarked by 1/31/97 EarlyLate EarlyLate MemberNonmember
SIGCSE Full Day: 7 10 11 12 13 $75$90 $100$120 N/AN/A
SIGCSE Half Day: 1 2 3 4 5 6 8 9 14 15 16 17 $40$50 $55$65 N/AN/A
SAC Tutorials: 1 2 3 4 5 6 $110$135 $140$165 N/AN/A

Financial Summary

Conference Registration fee $_____________
(from first table)

Workshops & tutorials fees $_____________
(from second table)

_____ Additional tickets for

SIGCSE luncheon @ $15 each $_____________

Total Payment Due (enclosed) $_____________

Payment Method

_____ Check enclosed made payable to ACM.

_____ Charge my credit card (circle one)

MasterCard Visa American Express

Card # _________________________________

Expiration Date __________________________

Signature _______________________________

Mail this form (and your payment) to: SIGCSE/SAC97 Registration, Department of Computer Science,

Campus Box 97, Rose-Hulman Institute of Technology, 5500 Wabash Avenue, Terre Haute, IN 47803-3999 USA