Registration form
CTRQ 2009

Colmar 20-25, 2009, Colmar, France 
(One registration allows one participant to assist to all the events in NexComm 2009)
 
Please fill in the form, sign it by hand, and send it via one of the following:
Fax: 1-302-475-6432
E-mail: manuela@vicov.com

Title (Student/Prof/Dr): ____First Name: _______________ Last Name: ______________

Paper number (e.g., #254) (for authors only: only one paper per form) ________________

Institution: _______________________________________________________________

Street Address: ___________________________________________________________

City: __________________ State: ____________ Zip: ___________ Country: ________

Phone: __________________ Fax: ___________________ Email: __________________

A. Conference Registration Fees
The full registration fees include: attendance to the conference, the coffee breaks, the gala dinner, and the CD-proceedings for the conference where the paper is registered (including IEEEXplore Publication).
 	IEEE Member	Non-IEEE Member	 	
Academic Rate
IEEE Membership # ………………	565 €	615 €	______ €	
Industry rate
IEEE Membership #........................	765 €	815 €	______ €	
Late payment *
- after April 15/2009, 100 €
- after May  15/2009, 150 €
* late payment acceptable for attendance only, not for paper registration	                                                                               
   ______ €	
Additional Proceedings: 100 €/CD	                                                                                 
   ______ €	
Extra pages: 105 € / page	
______ €	
Additional Gala Dinner: 95 €
(show, drinks, meals)							     
 ______ €	
    TOTAL A: __________ €
B. Tutorials 
Note: see final program
 
Tutorials are free of charge

C. Hotels 

Please see the recommended hotels on the “Hotels and Travels” to be booked by yourself.
They are all in a walking distance from the Place of the Events, The IUT - Colmar.

http://www.iaria.org/conferences2009/HotelsTravelCTRQ09.html

For touristic information on the location, please see:

http://www.iaria.org/conferences2009/TouristCTRQ09.html

D. Social event
(See Preliminary Program)

Strasbourg, Haut Koenigsbourg, Wine Degustation (full day with lunch)  155 € x __ person(s) = _______ €

If ‘credit card”:                                      TOTAL (A + D):       _________ €
If “wire transfer”:			     TOTAL (A + D + 40€):  ____________€

Payment of Fees (check one of the methods): 

__ By Credit Card   (preferred method)            (____ Mastercard or ____Visa)          
 
Card number:    _________________________________________________________
Expiration date:  _________                                                                   
Holder's Name: ________________________ Holder’s Signature: _________________
                                                                   
__ By Wire Transfer (please add 40 € for processing the wire transfer)
     Contact manuela@vicov.com for the wire transfer accounts information 
      
Date and Author’s Signature: ________________________________

Important: Please note that NO refund on any service mentioned above will be issued after April 15th, 2009 as all the services are ordered and paid when the registration is received. 
In case of an emergency that prevents the original presenter from attending, the registration may be transferred to another presenter.