MobiCom '95

Registration and Payment Information

Full conference registration includes admittance to all sessions, Monday's evening Welcome Reception, breaks, two lunches, one ticket for Tuesday's Dinner Banquet, and a copy of the conference proceedings. Student registration includes all of the above, except the Dinner Banquet.

Please fill in the form below, then mark the appropriate conference and tutorial fees. Finally, add charges for extra tickets to the Dinner Banquet and for extra Proceedings. Rates are quoted in US Dollars.


Registration Form:



_______________________________________________________________
Name

_______________________________________________________________
Company/Organization 

_______________________________________________________________
Address

_______________________________________________________________


_______________________________________________________________
Telephone Number

_______________________________________________________________
Fax Number 

_______________________________________________________________
Email Address 

_______________________________________________________________
URL(WWW) Address 

_______________________________________________________________
Name on Badge

ACM Membership #:______________________________________________
			(required for ACM member rate)

Exclude my address from:
         MobiCom Email list ___  Attendee Lists ____

ACM Membership

Attendees who are not currently ACM members may join now to take full advantage of discounted rates for MobiCom '95: 
  ACM Associate Member Dues	       $84_____
  ACM Student Dues                     $25_____

  Membership Fees                      $_______

Pledge

To advance the sciences and arts of information processing; to promote the free interchange of information about the sciences and arts of information processing both among specialists and among the public; and to develop and maintain the integrity and competence of individuals engaged in the practice of information processing. I hereby affirm that I subscribe to the purpose of ACM and understand that my membership is not transferable.

Signature________________________Date________

Conference Fees:

     Early Registration ends on October 20, 1995 


			   Before          After
			   10/20/95        10/20/95

   Full Day Tutorial Fee (T3)

      ACM Members:         $275____        $325____
      Non-members:         $350____        $400____
      Full-time students:  $135____        $175____ 

   Half Day Tutorial Fee (T1 & T2)

      ACM Members:         $180____        $225____
      Non-members:         $220____        $265____
      Full-time students:  $100____        $125____ 

   Conference Registration

      ACM Members:         $295____        $345____
      Non-members:         $375____        $425____
      Full-time students:  $100____        $135____ 


   Extra Dinner Banquet:   $50_____        $50_____
   Extra Proceedings:      $45_____        $45_____


   TOTAL FEES:             $________       $_______
   (Conference fees + Tutorials + Membership)



Vegetarian Meals:  Yes _____ No _____      



____________________________________________
Please specify any additional special needs:

Payment Method:

Enclosed:       Check ____  Money Order ____

Credit Card Type: (Only VISA or Mastercard, please)

Credit Card Number:____________________________

Exp. Date:_____________________________________

Cardholder Name:_______________________________
 	       (Exactly as printed on the card)     

Signature:
Please complete and return with check, credit card info or money order (no purchase order) to the registration chair. Registration accepted via postal mail, fax, or email only. Fax and email registration require credit card info. The registration fee must be paid in U.S. dollars.

Send Payment To:

MobiCom '95
Attn: Dr. Melody Moh
Dept. of Mathematics and Computer Science
San Jose State University
San Jose, CA 95192-0103, USA

Credit card payments also accepted via:
Fax: +1 408 924 5080
Email: mobicom95@cs.sjsu.edu

Note: Written requests for refunds must be postmarked no later than November 1, 1995. Refunds are subject to a US $50 service charge. Participants with confirmed registration who fail to attend or notify MobiCom Registration of cancellation before the refund date are subject to the full fee. Substitutions are allowed at any time. Registrations received after November 1, 1995 will be processed on-site only.