Register

The 46th IEEE MIDWEST SYMPOSIUM ON CIRCUITS & SYSTEMS Registration Form

Name:

Title:

Occupation:

Postal Address:

IEEE Membership#:

Email Address:

Author/ Co Author:

Yes		No

Students should present a current student photo ID

Fees:

Before Deadline

After Deadline

IEEE Member #

$ 295

$ 350

IEEE Non-Member

$ 350

$ 400

IEEE Life Member

$ 100

Student

$ 100

$ 150

Tutorial	Morning Session
	Afternoon Session

$ 20

$ 20

	Please enter quantity:
Extra Proceedings (CD)		* $10 =$
Proceedings (Hard Copy)		* $40 =$
Extra Lunch Tickets		* $15 =$
Extra Banquette Tickets		* $20 =$
Calculate SubTotal?	$

Method of Payment:

Money order

Payable to NSGB. Roushdy - Alexandria. Egypt Account # 110154110081011 / AAST (IEEEMW)
OR Citi Bank - Alexandria. Egypt Account # 0-026572-509 / AAST (IEEEMW)

			Exp. Date
Credit Card	Visa	Card #
	Master Card	Card #

Card Holder Name:

You might fax either the whole form or your card number separately to 203 562 2915

Print Registeration Form

For more information please contact: E-Mail: amal@eri.sci.eg - Mobile: 0106600134