IEEE Conference on E-Commerce Technology (CEC04)

Advanced Registration Deadline is April 20, 2004 for Authors
and May 20, 2004 for General Participants.

PDF-Version

Please print this form and FAX or send the form with your payment to the address at the bottom of this form.

First Name:______________________ Last Name:___________________________

Affiliation:_____________________________________________________________

Address:______________________________________________________________

City:____________________________ State/Province:________________________

Country:_____________________________ Zip Code:_________________________

E-mail:_____________________________ Phone: ___________________________

Fax:_______________________________ IEEE member number:_______________

Conference registration fees: (Please check all that apply)

Extra Banquet Tickets _____ @ $50.00 ea = $ ___________ Vegetarian?_____

Add up your above charges, and enter the total due below, payable in US dollars. Payment can be made with Visa, MasterCard, Amex, Check (payable to IEEE CEC04), Money Order or Bank. Please note that your credit card payment will be handled by "IEEE" for CEC04.

Total Due: US $ ________________

Payment Method: Check_____ Visa______ MasterCard______ American Express_______

Card Number: ________________________ Exp Date (MM/YY): ________________

Name on card: _______________________ Signature: ________________________

Bank Info:

Account No.: 11017-10404
Swift Code: 121000358
Bank Name: Bank of America (CA6-167-01-01)
Bank Address: 4101 MacArthur Boulevard, Newport Beach, CA 92660, USA
Account Holder's Name: IEEE (CEC 2004)

 

FAX (or mail your form with check) to the following address:

Prof. Kwei-Jay Lin
Dept EECS, Univ. California, Irvine
Irvine, CA 92697-2625
USA
fax: +1-949-824-2321
klin@uci.edu