UIST'95 Registration Form

Original signatures are required to process the registration fee. For this reason, e-mail registrations are NOT acceptable. Either U.S.-mailing or FAXing a completed form with a credit card number and your signature is acceptable.

Walk-in registrations are also acceptable. However, if you pre-register, we will be able to anticipate the number of conference attendants in advance. This will help us run the conference smoothly and plan the conference more effectively. So, if you could help us by pre-registering, we would greatly appreciate it. It is also significantly cheaper to preregister. Thank you.

Name: ___________________________   Affiliation: _______________________________

Address: _______________________________________________________________________

         _______________________________________________________________________

Telephone: ______________________   E-mail: ____________________________________

Special Requirements: __________________________________________________________

Do not include my name in the list of UIST'95 attendees: |__|

Circle one:
		Before Oct 17, 1995	After Oct 17, 1995
ACM Member:		$355			$500
Non-Member:		$440			$600
Full-time Student:	$165			$185

ACM Member Number: _________________________

Student registration must be accompanied by a clear photocopy of student id.

Extra Banquet Tickets ($35 each)................... # Tickets: ______

Extra Opening Reception Tickets ($15 each)......... # Tickets: ______

Extra copies of the UIST'95 video ($50 each)....... # Copies:  ______
	(This will contain the videos presented as 
	 part of talks at the conference.  One copy
         is included with each registration.)

UIST'95 T-shirt ($10 each) ......................... # Shirts: ______
	(full color UIST'95 logo on front, authors' names on the back)
	Specify size: S M L XL XXL  ___________

UIST '95 Video and Tee Shirts must be picked up at the hotel during the conference.
No refunds will be offered for merchandise that is not claimed at the conference.

Total Fees (US$ only): ___________

Payment form:
 __                    __           __                __
|__| Check Enclosed   |__| Visa    |__| MasterCard   |__| American Express

Make check out to: UIST'95. Checks must be drawn on a US bank.  

Credit Card #: __________________________    Expiration Date: __________________

Signature: _____________________________________________________________________

SEND REGISTRATION FORM AND FEE (by physical mail or FAX) TO:

Alison Lee
NYNEX Science & Technology
500 Westchester Avenue
White Plains, NY 10604
USA
FAX: +1 914 644-2561

If you have further questions regarding the conference registration, please contact Alison Lee at alee@nynexst.com