< Payment in US Dollars >

Early Registration Deadline    April 25, 2003
Late Registration Deadline     May 16, 2003


Date Reg. No. MEMO
/    

2003 VLSI Symposia
REGISTRATION FORM

Remittance for the 2003 Symposium is strongly encouraged to be paid in Japanese Yen, by the use of internationally recognized credit cards, and through the Japanese Secretariat.
However, for special cases where payment in US dollars is more convenient or required, please remit payment through the US Secretariat. Please contact the US Secretariat concerning any unusual circumstances or methods of payments.

Please complete and return this form to
Secretariat for VLSI Symposia (USA)
c/o Widerkehr and Associates
16220 S. Frederick Ave., Suite 312
Gaithersburg, MD 20877, USA
Tel: +1-301-527-0900 ext. 103 / Fax: +1-301-527-0994 / E-mail: vlsi@vlsisymposium.org

Please type or print in block letters to avoid trouble. [  ] Prof. [  ] Dr. [  ] Mr. [  ] Ms. / [  ] Speaker [  ] Committee


Name:

,
Family First Middle


Affiliation:
 

Mailing Address: [  ] Office [  ] Home:

Country

Tel:
+

Fax:
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Country Code Country Code

E-mail:

Registration Fee:

Conference

on or before
April 25

On or before May 16
and on-site

Student*
On or before May 16
and on-site
VLSI Technology Short Course  [  ] US$ 135  [  ] US$ 180  [  ] US$ 45
Symposium on VLSI Technology  [  ] US$ 455  [  ] US$ 500  [  ] US$ 180 *
Symposia on VLSI Technology and Circuits  [  ] US$ 865  [  ] US$ 955  [  ] US$ 275 *
VLSI Circuits Short Course  [  ] US$ 180  [  ] US$ 230  [  ] US$ 45
Symposium on VLSI Circuits  [  ] US$ 455  [  ] US$ 500  [  ] US$ 180 *
Silicon Nanoelectronics Workshop  [  ] US$ 180  [  ] US$ 230  [  ] US$ 90
Grand Total US$
*Student registration fee does not include dinner. Dinner tickets will be available at the registration desk for an additional fee.


Remittance:

[  ]
I have enclosed a personal check, company check or bank draft in US Dollars for the above grand total payable to the order of the 2003 VLSI Symposia.


[  ]
I have enclosed payment, in a form that has been agreed to by Widerkehr and Associates, in US Dollars for the above grand total payable to the order of the 2003 VLSI Symposium.


Cancellation:If written notice of cancellation reaches the Japanese Secretariat:
On or before May 16 Cancellation fee, US $45 will be deducted before refunding the fee.
After May 16 No refund. A copy of the digest will be sent after the symposium.