Payment must be made by US dollar check payable to ISPA, or by Visa or Mastercharge.
Sorry, foreign-currency checks.
POs must be approved by the registrar prior to the conference.

Fax to	Faith E. Perry - ICSP5 Registrar
	c/o Dewayne E. Perry (+1.908.582.5809)

OR
Mail to	Faith E. Perry
	ICSP5 Registrar
	125 Beechwood Road
	Summit NJ 07901


Conference Registration Costs (lunches included):

   Tutorials		 By 29 May	After 29 May
      Student		   $100		   $150
      Regular		   $250		   $300		________

   Conference
      Student		   $150		   $200
      Regular		   $375		   $450		________

						Total:	________


   For companies sending 5 or more people to the conference, contact
   Dewayne E. Perry (dep@research.bell-labs.com or +1.908.582.2529)
   for industrial sponsor and group rates.


Name:	___________________________________________________________

Company:___________________________________________________________

Address:___________________________________________________________

	___________________________________________________________

	___________________________________________________________

Email:	___________________________________________________________

Phone:	___________________________________________________________

Fax:	___________________________________________________________


Method of Payment:  Check: ____  Visa: ____  Mastercard: ____

Card number: _____________________________________________________

Expiration date: _________________________________________________


Signature: _______________________________________________________