To register, print and complete the form below and mail or FAX, to: Ms. Kusum Shori Email: kusum@usc.edu Attn: NOSSDAV Registration Voice: +1 213-740-7286 Computer Science Department FAX: +1 213 740-7512 University of Southern California 941 W. 37th Place Los Angeles, CA 90089-0781 USA ----------------------------------------------------------------------- NOSSDAV 2002 REGISTRATION FORM First Name: ___________________________________________________________ Last Name: ___________________________________________________________ Affliation: ___________________________________________________________ Email: ___________________________________________________________ Street Address: _______________________________________________________ City: ________________________________ State/Provence: _______________ Zip/Postal Code: ______________________________ Country: ______________ Telephone: ________________________ FAX: _____________________________ ACM Member? Yes___ ACM #: ______________________________________ No___ Full-time Student? ___ Yes ___ No [Students must supply evidence of student status (e.g. student ID) at the conference] DIETARY RESTRICTIONS: Vegetarian Other (specify): _____________________ PAYMENT INFORMATION: Registration Fees On or Before May 10, 2003 After May 10, 2003 ACM Member $400 $450 Non-ACM Member $450 $500 Student $300 $350 Payment Method (check one): ___ Check ___ Money Order ___ Credit Card Check or money order must be made in US dollars, payable to: ACM NOSSDAV 2003. For credit card transactions please fill out the information below: Credit Card (check one): ___ Visa ___ MasterCard ___ American Express Credit card number:_____________________________________________________ Expiration Date:________________________________________________________ Name on the credit card:________________________________________________ Total Charges Authorized (see chart above):_____________________________ Signature: ____________________________________________________________ Please note that any credit card information you fax or sent via physical mail will be entered on-line into a secure payment server for processing. Signing above also indicates your approval of this transmission. For further information please contact the program chairs Christos Papadopoulos or Kevin Almeroth ------------------------------------------------------------------------