2003 IEEE Symposium on Security and Privacy Registration Form

Name: ___________________________________________________

Affiliation: _______________________________________________

Postal Address: ___________________________________________

________________________________________________________

________________________________________________________

Phone: __________________________________________________

Fax: ____________________________________________________

Email: __________________________________________________

Note: Address information will be distributed to attendees.
If you do not wish to have your address included in the attendees list, please check here

[  ]

Please enter the appropriate registration category.  Payment must be included and must be
either by check in U.S. dollars, drawn on a U.S. bank and made payable to
"IEEE Symposium on Security and Privacy," or by credit card.  Dates are strictly enforced by postmark.

Advance registration (up to 6 April 2003)

__ Member:             $360.00

   IEEE or Computer Society Member #_____________________, required

__ Non-Member:         $445.00

__ Full-time student: $150.00

Late/on-site registration

__ Member:             $420.00

   IEEE or Computer Society Member #______________________, required

__ Non-Member:         $520.00

__ Full-time student: $175.00

Do you wish to present at a poster session or lead an evening discussion? [ ] Yes [ ] No

Do you require vegetarian meals? [ ] Yes [ ] No

Please indicate your method of payment by checking the appropriate box:

[  ] Check in U.S. funds drawn on a U.S. bank (PLEASE ENCLOSE WITH THIS FORM)

Credit card authorization: (Charges will appear on your statement as made
by the IEEE COMPUTER SOCIETY.  Your credit card number will be transmitted
to the IEEE over the Internet, using an SSL-protected link.)

[  ] Visa   [  ] Mastercard  [  ] American Express  [  ] Diners Club

Credit Card Number:

Card Holder Name:

Expiration Date:

Signature (required for credit card payments)

Mail registration to:

Lee Badger
DARPA/IPTO
3701 North Fairfax Drive
Arlington, VA 22203-1714, USA

Or fax this form (credit card registrations only) to:

FAX +1-703-248-1879

NO REGISTRATIONS BY EMAIL.  NO REFUNDS.