SYMPOSIUM AUTHOR REGISTRATION FORM

4^th IEEE International Symposium on Signal Processing and Information Technology

December 18-21, 2004, Rome, Italy

Sponsored by

IEEE Computer Society* and IEEE Signal Processing Society**

(*Technical Committee on Simulation)

(**Technical Committee on Signal Processing for Communication)

All registration fees must be received by October 30th, 2004 in order for your paper(s) to be published in the proceedings.

Please complete this form (TYPE or PRINT):

Title (Dr./Mr./Mrs./Ms.): ____ First Name: __________________ MI ____ Last Name:_________________

Affiliation: _____________________________________________________________________________

Address _____________________________________________________________________________

City: _____________________________ State/Province: __________________________________

Zip/Postal Code _____________________________ Country: __________________________________

Telephone: ______________________________ Fax: __________________________________

E-mail: _____________________________________________________________________________

PAPER NUMBER (for author only): _____________________________________________________________

FEES:

Methods of Payment: Credit card: __________ Bank transfer: _____________ Check: _____________

1. Registration fee

Non-IEEE Members $ 525.00 (USD)

IEEE Members $ 400.00 (USD) (IEEE # ____________________ )

Students (Non IEEE member) $ 300.00 (USD)

Students (IEEE members) $ 200.00 (USD) (IEEE # ____________________ )

Additional copy of the proceedings $ 50.00 (USD)

Registration fee = $__________________ US Dollars

Registration includes: Proceedings (Abstracts, CD ), Banquet Ticket, Coffee breaks, and free tutorials

2. Extra-page Charges (for authors only)

You are allowed 4 - 6 pages for your paper.

You may, as an exception, use up to 2 extra pages at a charge of $100.00 USD per extra page.

Number of extra pages x $100.00 = $__________________ US Dollars

TOTAL FEES (Sum of items 1, 2, and 3) $__________________ US Dollars

ACCEPTED METHODS OF PAYMENT:

Please attach the exact payment in one of the following three forms:

1. A check or money order drawn on a U.S. Bank and made out to: “IEEE ISSPIT 2004”

2. Credit card (Visa or MasterCard only) PLEASE TYPE or PRINT CLEARLY

Registration for: ___________________________________________________

Card Number ___________________________________________________

Expiration Date ___________________________________________________

Amount (USD) ___________________________________________________

Cardholder Name ___________________________________________________

Cardholder Address ___________________________________________________

___________________________________________________

Signature ___________________________________________________

3. A proof of direct transfer to

People’s Bank

2075 Hillside Road

Storrs, CT 06269

Account Number: 230-7001105

ABA/Routing Number: 221172186

Please send/fax/e-mail this form and full payment in US Dollars As Soon As Possible (ASAP) to:

Address: Prof. Reda A. Ammar

U-3155, Computer Science and Engineering Dept.

University of Connecticut

Storrs, CT 06269-3155 USA

Fax: 01-860-486-4817

· We reserve the right to cancel the publication of a paper if the registration fee is not paid on time.