ACM Computing Week '96 Registration Form for Students First Name ___________________________________ M.I.______ Last Name _______________________________________________ Name or Nickname (for Badge) ____________________________ School __________________________________________________ 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 | Student | Amount Cut-off for early registration: | Member | Nonmember | Due 1/15/96 | Early Late | Early Late | --------------------------------------+ ----- ---- + ----- ---- |------ SIGCSE Technical Symposium (SIGCSE) | $20 N/A | $30 N/A | --------------------------------------+----------- + -----------+------- Computing Week (Joint CQL, SAC, CSC, | | | SIGCSE) | $75 $75 | $100 $100 | --------------------------------------+------------+------------+------- 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 | $200 $200 | | --------------------------------------+------------+------------+------- Half Day 4 5 6 | $135 $135 | | --------------------------------------+------------+------------+------- 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