ACM Computing Week '96 Registration Form for Professionals First Name ___________________________________ M.I.______ Last Name _________________________________________ Name or Nickname (for Badge) ____________________________ Company ________________________________________________ Address ________________________________________________ ________________________________________________ City _______________________State _______________________ Zip ____________________ Country ____________________ Daytime Phone Number ______________________ Home Phone Number______________________ Fax _____________________ EMail Address ________________________________________ Member#_______________________________________ [ ] Check here if you do not want your name included on attendee lists made available to outside organizations. [ ] Special services required____________________________ _____________________________________________________ --------------------------------------+------------+------------+------- Type of Registration | Member | Nonmember | Amount Cut-off for early registration: | | | Due 1/15/96 | Early Late | Early Late | --------------------------------------+ ----- ---- | ----- ---- + ------ Computers & the Quality of Life (CQL) | $145 $165 | $195 $215 | --------------------------------------+------------+------------+------- Computer Science Conference (CSC) | $195 $275 | $295 $375 | --------------------------------------+------------+------------+------- One-Day Only | $ 95 $150 | $200 $280 | --------------------------------------+------------+------------+------- SIGCSE Technical Symposium (SIGCSE) | $105 $120 | $155 $170 | --------------------------------------+------------+------------+------- Symposium on Applied Computing (SAC) | $195 $220 | $250 $275 | --------------------------------------+------------+------------+------- CQL and SAC | $310 $355 | $415 $460 | --------------------------------------+------------+------------+------- CQL and CSC | $310 $410 | $460 $560 | --------------------------------------+------------+------------+------- CQL and SIGCSE | $220 $255 | $320 $355 | --------------------------------------+------------+------------+------- SAC and CSC | $360 $465 | $515 $620 | --------------------------------------+------------+------------+------- SAC and SIGCSE | $270 $310 | $375 $415 | --------------------------------------+------------+------------+------- CSC and SIGCSE | $270 $365 | $420 $515 | --------------------------------------+------------+------------+------- Computing Week (Joint CQL, SAC, CSC, | | | SIGCSE) | $580 $720 | $835 $975 | --------------------------------------+------------+------------+------- For any other combinations add fees for each of the selected | conferences, and then deduct $15 off the full price for each | --------------------------------------+------------+------------+------- Tutorials and Workshops | --------------------------------------+------------+------------+------- CSC | --------------------------------------+------------+------------+------- Full Day 1 2 3 | $240 $270 | $270 $300 | --------------------------------------+------------+------------+------- Half Day 4 5 6 | $155 $185 | $185 $215 | --------------------------------------+------------+------------+------- SAC | --------------------------------------+------------+------------+------- Tutorials 1 2 | $90 $115 | $120 $145 | --------------------------------------+------------+------------+------- SIGCSE | --------------------------------------+------------+------------+------- Full Day 2 8 9 10 | $75 $90 | $100 $120 | --------------------------------------+------------+------------+------- Half Day 1 3 4 5 6 7 11 12 13 14 15 | $40 $50 | $55 $65 | --------------------------------------+------------+------------+------- Other | --------------------------------------+------------+------------+------- Special Guest Pass | $25 $25 | $25 $25 | --------------------------------------+------------+------------+------- Tickets for CQL Luncheon _____ X $30 = | --------------------------------------+------------+------------+------- Additional Tickets for SIGCSE Luncheon _____ X $30 = | --------------------------------------+------------+------------+------- ACM Awards Banquet (Sat 2-17) Tickets _____ X $50 = | --------------------------------------+------------+------------+------- ENIAC Dinner Tickets for CQL, CSE, SAC, and CSC Registrants | _____ X $60 = | --------------------------------------+------------+------------+------- Total Payment Due (and enclosed) |$ --------------------------------------+------------+------------+------- We accept checks or credit cards. Make checks payable to ACM Computing Week '96. Credit Card (check one) [ ] MasterCard [ ] Visa [ ] Amex Credit Card #: _____________________________________ Expiration Date __________ Signature ______________________________________________________________ Mail this form and your payment to: ACM Computing Week '96 Registration, Dept. of Computer Science Campus Box 97, Rose-Hulman Institute of Technology 5500 Wabash Ave., Terre Haute, IN 47803-39999 USA; email: cwregis@acm.org