NOSSDAV 2003 Registration Form

You may register by filling the registration form below and submiting it via email,

regular mail or fax. An ASCII version of the form can be found here.
 

Ms. Kusum Shori

Attn: NOSSDAV Registration

Computer Science Department

University of Southern California

941 W. 37th Place

Los Angeles, CA 90089-0781

USA

Email: kusum@usc.edu
 

Voice: +1 213-740-7286
 

FAX: +1 213 740-7512

 



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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.

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For further information please contact the program chairs:

Christos Papadopoulos and Kevin Almeroth