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	Early	Late	Early	Late	Member	Nonmember
SIGCSE Technical Symposium (SIGCSE)	$115	$130	$165	$180	$20	$30
Symposium on Applied Computing (SAC)	$245	$270	$300	$325	N/A	N/A
Joint SIGCSE/SAC	$340	$380	$445	$485	N/A	N/A
Exhibits only	$25	$25	$25	$25	N/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	Early	Late	Early	Late	Member	Nonmember
SIGCSE Full Day: 7 10 11 12 13	$75	$90	$100	$120	N/A	N/A
SIGCSE Half Day: 1 2 3 4 5 6 8 9 14 15 16 17	$40	$50	$55	$65	N/A	N/A
SAC Tutorials: 1 2 3 4 5 6	$110	$135	$140	$165	N/A	N/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 _______________________________