AICT/SAPIR/ELETE 2005 Registration Form 

Along with your registration form, please send to petre@iaria.org and oana@vicov.com the pdf file of your final paper version.

Registration form can be sent by email (preferred), fax 

Title (Prof, Dr, student): _____ First Name: _________ Last Name: _______________ 
Paper number generated by EDAS (for authors only, one paper per from): ____________
Institution: ________________________________________________________________
Street Address: ____________________________________________________________
City: _________  State: ____________  Zip: ___________  Country: __________________
Phone: ______________ Fax: _______________ Email : ___________________________
The full registration fees include: attendance to the conference, the reception, the coffee breaks, the gala dinner and the proceedings.
 
 	Non Member	IEE-IEEE-SEE, Member	 	
Academic Rate Membership #	500 €	450 €	______ €	
Industry rate Membership #	700 €	650 €	______ €	
Additional Conference Proceeding: 100 €	                                                                                                  ______ €	
Additional Gala Dinner: 60 €	                                                                                                  ______ €	
Additional extra pages (100 € per page)  	                                                                                                  ______ €	
Tutorial #1 (150 €)

Tutorial #2 (150 €)	                                                                                                  ______ €

                                                                                                  ______ €	
Hotel special price (LIMITED to the first 100 registrations)
Arrival date   __________ Departure date ____________   Number of nights ___
 
Holiday Inn (room for 1 or 2 person)                                              105  € x ___nights  = ____
Holiday Inn (room for 1 person with 1 breakfast and 1 lunch)          141  € x ___nights  = ____
Holiday Inn (room for 2 persons with 2 breakfasts and 2 lunches)    177  € x ___nights  = ____

Total Euros:      _________
Payment of Fees: 
__ By Foreign Check in Euro to “VICOV Event Expert LLC.", using the address above
 
__ By Credit Card   (__ MasterCard __ Visa)   
            Card number:    _____________________ / Secure digits ____________(*)
             Expiration date:  _____/_____                Holder's Name : ____________________
                                      Date / Signature: …………… / ………………….
Important: 
- (*) secure digits are the 3 digits on the back of Visa et al, listed after the card number
- Please note that NO refund will be issued after April 15, 2005