SUPERCOMPUTING '96
November 17-22, 1996
Conference Registration Form


Print in black ink or type. DO NOT SEND THIS FORM WITHOUT PAYMENT. Form must be postmarked or faxed by October 25. You must register on site after October 25. 
Name: ___________________________________________________________________________________
(As you would like it to appear on your badge)	Last, First, Middle
Affiliation: ____________________________________________________________________________
Are you exhibiting?  If so, exhibiting organization______________________________________
Address: ________________________________________________________________________________
City: __________________________________  State: ________________ Zip Code ______________
Country: ________________________________________________________________________________
E-mail address: _________________________________________________________________________
Telephone: _________________________________________  Fax: ______________________________

Membership

Member numbers must be provided to receive member rates.

________ ACM and/or SIGARCH Member #________________________________________________
________IEEE Member and/or IEEE-CS Member #_________________________________________
________Non-member _________________________________________________________________
________Full-Time Student___________________________________________________________
	  (must attach a copy of your valid student identification card.)

Mailing Lists

___Do not include my name, address or phone number in a published electronic list of attendees.

___Do not include my name, address or phone number on a non-society mailing list.

Please return this form along with payment to:
IEEE Computer Society
Attn: Supercomputing '96
PO Box 18405
Washington, DC 20036-8405 USA
202-371-1013 phone
202-728-0884 fax

Technical Program Registration

Includes admission to the technical program, exhibition, social events and one copy of the proceedings.

If postmarked or faxed on or before October 12 (advance):

Member: 	$350
Non-member:	$460
Student: 	$100
If postmarked or faxed after October 25 (late):
Member: 	$425
Non-member: 	$535
Student: 	$100

A. Enter Technical Program registration fee from: $_______________

Tutorial Passport Registration

Tutorial Passport Registration includes admission to any or all tutorials offered on the selected day for a one-day passport and on both days for a two-day passport. The Passport also includes the selected set of tutorial notes (for each day of Passport purchased) and lunch for each day of Passport. Please circle the set of notes desired for each day registered. All tutorials are full days. 

SUNDAY:  	S1  S2  S3  S4  S5  S6  S7  S8
MONDAY:  	M1  M2  M3  M4  M5  M6  M7  M8

One-Day Passport

Advance Registration (postmarked or faxed on or before October 12): 
Member	$375
Non-member 	$490
Student 	$100

Late Registration (postmarked or faxed after October 25): 

Member	$450
Non-member	$570
Student	$125

Two-Day Passport

Advance Registration (postmarked or faxed on or before October 12): 

Member 	$600
Non-member 	$785
Student	$160
Late Registration (postmarked or faxed after October 25): 

Member	$720
Non-member 	$910
Student	$200
B. Enter total Tutorial Passport registration fee from above: $_______

K-12 Teacher Registration

Teachers who are employed full time by a public, private or parochial school (K-12) are eligible for the special $200 teacher registration fee. The signature of their shcool principal or superintendent and the school name, city location and district number must be provided on the registration form when submitted. 

Rate: $200
School Name and City: ___________________________________________________________________
District No.: ___________________________________________________________________________
Signature of Principal or Superintendent: _______________________________________________
C. Enter teacher registration fee: $_________________________

D. For international wire transfers, add $25 fee: $_______ (A copy of the wire transfer transaction must accompany this form.)

E. Total payment due, U.S. funds drawn on U.S. banks only (A+B+C+D) $:______________

Method of Payment (please check one)

______Company check #:_______________________
______ Personal check #:________________________  
______U.S. Government Purchase Order (original P.O. must be included)
______Transfer by wire
 American Express:____   Diners Club:____   MasterCard:____   Visa:____
Card number:__________________________________________________________
Cardholder name:______________________________________________________
Exp. Date:____________________________________________________________
Signature:____________________________________________________________

Checks and purchase orders should be made payable to the IEEE Computer Society. All checks must be in U.S. funds drawn on U.S. banks only. All credit card charges will appear as IEEE COMPUTER SOCIETY REGISTRATION on your statement.