ATTENDEE REGISTRATION FORM:  IEEE ISSPIT 2002

December 18-21, 2002    Kenzi farah Hotel, Marrakesh, Morocco

Please complete this form (TYPE or PRINT) and return by November 18th , 2002 for early registration rate.

FIRST Name: _________________MI _____ LAST Name: _______________________________________________

Title ( Dr / Mr / Mrs / Ms ): _________Position: ________________   Organization: ___________________________

Address: ______________________________________________________________________________________

City: ___________ State/Province: _____________   Zip/Postal Code _____________ Country: ________________

Telephone:   ___________________________  Fax:    ____________________________________________________

E-mail:   ______________________________  List your areas of interest: ___________________________________

EARLY REGISTRATION FEE (RECEIVED BY OCTOBER 6th, 2002)
MEMBER	$400	_________
NON-MEMBER	$500	_________
* STUDENT	$200	_________
REGISTRATION FEE (RECEIVED AFTER November 18th, 2002)
MEMBER	$450	_________
NON-MEMBER	$550	_________
* STUDENT	$250	_________
Additional IEEE ISSPIT 2002 Proceedings :	$50
	TOTAL:	_________

METHOD OF PAYMENT:   ___Check Enclosed    ___Money Order    ___Visa    ___ MasterCard

(Credit Card No.):    ___   ___   ___   ___    -   ___   ___   ___   ___    -   ___   ___   ___    ___    -   ___   ___   ___   ___

Expiration Date ________/_______         Print Name as it appears on Card: ____________________________________

ZIP/POSTAL CODE of  billing address: ______________________ (REQUIRED)

___________________________________ (Signature)