Registration for MobiCom'96


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Name

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Company/Organization 

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Address

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Telephone Number_______________________FAX_____________________


URL(WWW) Address_______________________Email___________________


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Name on Badge

ACM Membership #:______________________________________________
                        (required for ACM member rate)

If you are not currently an ACM member, you may join ACM now to take full advantage of discounted rates. Mention ``new member" when you send this form and your payment to the registration chair. Send your membership dues directly to ACM at: Phone 1-800-342-6626 or +1-212-626-0500, FAX: +1-212-944-1318, Email: acmhelp@acm.org, http://www.sigmobile.org/about/membership.html.


Exclude my address from:
         MobiCom Email list ___  Attendee Lists ____

Conference Fees:

Tutorials (Check each tutorial attending) Morning Session, 8:30 A.M. - 12:30 P.M. (choose one) [] T1 Disconnected Browsing : WWW & Mobile Computing [] T2 Air Interface Standards Afternoon Session, 1:30 P.M. - 5:30 P.M. (choose one) [] T3 Secure Mobile Communications [] T4 Mobile Networking within the IETF Early Registration Late Registration Before 10/18/96 After 10/18/96 Fee for each Tutorial ACM Members: $180____ $225____ Non-members: $220____ $265____ Full-time students: $100____ $125____ Total fee for Tutorials ________ _______ Conference Registration* ACM Members: $320____ $370____ Non-members: $400____ $450____ Full-time students#: $125____ $155____ Extra Dinner Banquet: $55_____ $55_____ Extra Proceedings: $45_____ $45_____ *includes proceedings, sessions, reception, lunches and banquet #includes proceedings, sessions, reception and lunches Total Fees $________ $_________ Vegetarian Meals: Yes _____ No _______ ___________________________________________________________ Special needs: (Please describe)

Payment Method:


[] Check or money order payable to MobiCom'96

[] VISA		[] Mastercard (Only VISA or Mastercard, please)

Credit Card Number:____________________________

Exp. Date:_____________________________________

Card holder Name:_______________________________
               (Exactly as printed on the card)

Please complete and return with check, credit card info or money order (no purchase order) to the registration chair. Click here to download a PostScript or plain text version of the registration form. Registration accepted via postal mail, fax, or email only. Fax and email registration require credit card info. The registration fee must be paid in U.S. dollars.

Send Payment To:

Attn: MobiCom'96
Pravin Bhagwat
T.J. Watson Research Center
P.O. Box 704
Yorktown Heights, NY 10598, USA

Credit card payments also accepted via:
Fax: +1 914-784-6025
Email: pravin@watson.ibm.com

Note: Written requests for refunds must be postmarked no later than November 1, 1996. Refunds are subject to a US $50 service charge. Participants with confirmed registration who fail to attend or notify MobiCom Registration of cancellation before the refund date are subject to the full fee. Substitutions are allowed at any time. Registrations received after November 1, 1996 will be processed on-site only.