AUTHOR REGISTRATION
2005 IEEE IMS WORKSHOP REGISTRATION FORM
Lake Buena Vista Resort Hotel, Orlando Florida, 29-30 March 2005
NOTICE: ADVANCE REGISTRATION CONTINUES UNTIL 10 MARCH 2005

_________________________________________________________________________________________________________ 
Last (Family) Name						First (Given) Name				Middle Name (initial)

_________________________________________________________________________________________________________ 
Organization						Street Address

_________________________________________________________________________________________________________ 
City			State/ Province 			Country					Postal Code

_________________________________________________________________________________________________________ 
Phone Number			Fax		 	E-mail Address 				IEEE Member Number
 		(for Member Discount)
All Fees are in U.S. Dollars 	IEEE 		Non-			
Conference Registration		Member		Member							Amount
Till 10 March 2005		US$340		US$425						
From 11 March 2005 	 	US$425		US$540							_______
Member and Non-Member registration includes one copy of the CD-ROM proceedings, entrance to sessions, coffee breaks, 2 lunches, and the Thursday Evening Banquet.

Every registration can cover up to one paper. If an author is the only author of several papers one registration is due to cover the first paper and a mandatory processing charge of 50 US$ is due for each paper in excess of one.
Members to whom the society bylaws grant special discounts (e.g., the life-time members of the IEEE) cannot use the discounted rates to cover the publication of an accepted paper: they have to pay the member fee.

Paper Number and Title covered by this Registration (your registration can cover only papers of which you are an author)
Paper Number:	IMS-			First Words of Paper Title:

Additional Paper(s) covered by this registration ($50 each - your registration can cover only papers of which you are an author)
Paper Number:	IMS-			First Words of Paper Title:
Paper Number:	IMS-			First Words of Paper Title:
Additional Papers Processing Fee		Number _______ Additional Papers at US$ 50  each		_______
Additional CD-ROM Conference Proceedings (conference registrants only)	IEEE Member	Non- Member	
Only a limited number will be available from 11 March 2005			US$40 		US$50
Number of Copies of the CD-ROM Proceedings  __________________  					_______
Additional Lunch Tickets 			Number _______Tickets  at 	US$ 20     each		_______
Additional Wednesday Evening Banquet Tickets 	Number _______Tickets  at 	US$ 45     each		_______
                                                                                                        		     	Total Amount	______________
Payment: Check or credit card. (for bank transfer, please add $25 handling fee to the total amount)
Make check payable to the IEEE Instrumentation and Measurement Society. Do NOT send currency.

Indicate Credit Card: 		AMEX  ____________		MasterCard  ____________  	    Visa  ____________

Credit Card Number ______________________________________________________________ EXP. DATE: _________ ______

Name of the Card Holder as it appears on Card: __________________________________________________________________

Signature: __________________________________________________________________  Date: ________________________

THE LINE ITEM ON YOUR CREDIT CARD WILL READ: MYERS/SMITH, INC.

Send this registration form by ONLY ONE of the following ways:
E-Mail:		lee.myers@ieee.org
or Mail: 		IEEE  IMS 2005 c/o Lee Myers 799 North Beverly Glen, Los Angeles, CA, 90077 USA.  
or Fax: 		+1-310-446-8390