REGISTRATION FORM

Please write in block capitals or type and return this form by 1 May 1998 to:

ICEM'98 Conference Office, Prof.Dr. H.Bülent Ertan, Electrical and Electronics Engineering Department, Middle East Technical University, 06531 Ankara TURKEY

Fax: + (90) 312 210 12 61 + (90) 312 210 11 10

Delegate

Title: Prof./Dr./Mr./Mrs./Ms. (please circle as appropriate)

Surname: ................................................. First Name(s): ..........................................................

Name of Organization: ..............................................................................................................

Address: ...................................................................................................................................

Postal Code & Town: ............................................. Country : .................................................

Tel: .................................... Fax : ................................... E-mail: ..........................................

Accompanying Person

Mr./Mrs./Ms. (please circle as appropriate)

Surname: ................................................. First Name(s): .......................................................

REGISTRATION FEES

ICEM'98 Registration

Normal Registration: 530 US $ .......... Late Registration: 580 US $ ..........

ELECSHIP'98 Registration

Registration 250 US $ .......

ICEM-ELECSHIP Joint Registration

Normal Registration: 700 US $ ......... Late Registration: 750 US $ ..........

Accompanying Person

Normal Registration: 200 US $ ......... Late Registration: 220 US $ ..........

Additional Page: 50 US $ .......... Additional Paper: 200 US $ ..........

TOTAL ...............

....... I may not be able to attend the conference.

PAYMENT INFORMATION

Remittance in American Dollars by:

...... cheque to "ICEM'98 Account Prof. Dr. H. Bülent Ertan".

...... credit card (Visa, Mastercard or Eurocard only). In this case, please give the following data:

Charge the amount of US $ ............ to my credit card: ............Visa ............Mastercard ..........Eurocard

Name of credit card holder: ................................... Card No: ..................................................

Expiry date: ...................... Signature: ...................................... Date: ...................................