Registration form
ICN 2011
January 23-28, 2011 - St. Maarten, The Netherlands Antilles 
(One registration allows one participant to assist to all GlobeNet 2011 events)
 
Please fill in the form, sign it by hand, and send it via one of the following:
Fax: 1-302-397-2096
E-mail: andrea@vicov.com

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

Paper number (e.g., #10254) (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: access to all the conferences, the welcome cocktail, the coffee breaks, the gala dinner, the CD-proceedings for the conference where the paper is registered (including archiving, publication, and indexing), and the participation to all the scientific events under the GlobeNet 2010 umbrella. 
 	IEEE Member
IARIA Fellows	Non-IEEE Member	 	
Academic Rate
IEEE Membership # ………………	565 €	615 €	______ €	
Industry rate
IEEE Membership #........................	765 €	815 €	______ €	
Additional late fee *
- after November 12 /2010, 100 €
- after December 12/2010, 150 €
* late payment acceptable for attendance only
* authors must register before November 12	                                                                               
   ______ €	
Additional Proceedings: 100 €/CD	                                                                                 
   ______ €	
Extra pages: 105 € / page
(over 6 pages) 	
______ €	
Additional Gala Dinner: 95 €							     
 ______ €	
    TOTAL A: __________ €
B. Tutorials 
Note: see final program
 
Tutorials are free of charge for all the attendees

C. Hotels (special group rate limited to the first 60 registrants)
NOTE: The hotel negotiated room rates already include the 21% tax. Other booking services will advertise costs, and then add the taxes at the end. Keep that in mind as you plan your trip.

Conference Hotel:
Sonesta Maho Beach Resort & Casino 
Maho Bay - Rhine Road 1, St. Maarten, Netherlands Antilles

arrival date:___________________________  departure date:_______________________________

- Ocean/Pool view (single or double)				180 € x ___nights  = _______
- Ocean/Pool view (single) + 1 breakfast				192 € x ___nights  = _______
- Ocean/Pool view (double) + 2 breakfasts				204 € x ___nights  = _______
- Ocean/Pool view (single) + 1 breakfast	 + 1 dinner		216 € x ___nights  = _______
- Ocean/Pool view (double) + 2 breakfasts + 2 dinners		255 € x ___nights  = _______

Total C: __________ €

D. Social Event - Tour [January 28, 2011]

Sint Maartin Island Tour                                           100 € x __  persons = _____

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

Payment of Fees (check one of the methods): 

__ By Credit Card   (preferred method)            (____ Mastercard or ____Visa)          
 
Card number:    _________________________________________________________
CVV:  _________________ (this is the 3 or 4 digit number on the back of the card)
Expiration date:  ___________                                                                   
Holder's Name: ________________________ Holder’s Signature: _________________

Credit Card billing address:
Street address:________________________________________________________
City: _______________________________ State: ___________________________
Zipcode/Postcode _____________________ Country: ________________________
                                                                   
__ By Wire Transfer (please add 40 € for processing the wire transfer)
     Contact andrea@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 November 12, 2010 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.