First Name:      
Last Name:       
Title:           
Company Name:    
Address Line 1: 
Address Line 2:  
City:           ,  State:   ZIP: 
Country:         
Phone Number:   
Fax Number:     
E-Mail Address:  

You may register by

Early Registration Fee(until October 9, 1997)
Academic $245 Industry $295

Late Registration Fee
Academic $295 Industry $345

Georgia residents only: $245 flat

Georgia Tech participants will be eligible for a $100 grant to subsidize their conference participation costs.

Payment

Credit Card - non-encrypted Credit Card transaction
Visa
Discover
MasterCard
American Express
Card Number:
Expiration Date:
Cardholder's Name:

Payment by check should be sent to:

Georgia Institute of Technology
Registration
PO BOX 93686
Atlanta, GA 30377-0686