IEEE Conference on Electronic Commerce

The First IEEE International Workshop
on Electronic Contracting (WEC)

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




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:___________________________



City:____________________________ State/Province:________________________

Country:_____________________________ Zip Code:_________________________

E-mail:_____________________________ Phone: ___________________________

Fax:_______________________________ IEEE member number:_______________

Conference registration fees: (Please check all that apply)

By May 20, 2004 After May 20, 2004
IEEE member $200______________ $250______________
Non-IEEE member $250______________ $300______________
Full-time student IEEE member $150______________ $175______________
Full-time student Non-EEE member $175______________ $200______________

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 WEC04) or Money Order. Please note that your credit card payment will be handled by "IEEE" for WEC04.

Total Due: US $ ________________

Payment Method: Check_____ Visa______ MasterCard______ American Express_______

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

Name on card: _______________________ Signature: ________________________

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

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