Cyber-Physical Systems Week Registration Form

1. Please put an X next to the appropriate registration type:

                                                  by 3/31/08     4/1/08 on

___ IEEE/ACM member (conference only)              $620.00        $750.00    

___ IEEE/ACM member (workshops only)               $225.00        $275.00
 
___ IEEE/ACM member (conference+workshops)         $845.00      $1,025.00
 
___ non-member (conference only)                   $775.00        $940.00
 
___ non-member (workshops only)                    $275.00        $350.00
 
___ non-member (conference+workshops)             $1050.00      $1,290.00 
 
___ IEEE/ACM member student (conference only)      $360.00        $440.00
 
___ IEEE/ACM member student (workshops only)       $175.00        $225.00
 
___ IEEE/ACM member student (conference+workshops) $535.00        $665.00
 
___ non-member student (conference only)           $460.00        $550.00
 
___ non-member student (workshops only)            $225.00        $275.00
 
___ non-member student (conference+workshops)      $685.00        $825.00
 

2. If your registration includes conference attendance, please put an X
   next to the conference you would like to designate as your home conference:

   ___ HSCC          ___ IPSN            ___ RTAS


3. If your registration includes workshop attendance, please put an X
   next to the workshop you would like to designate as your home workshop:

   ___ International Workshop on Mobile Device and Urban Sensing (MODUS)

   ___ Workshop: From Embedded Systems to Cyber-Physical Systems

   ___ The 2nd Workshop on Event-Based Semantics

   ___ Workshop on Adaptive and Reconfigurable Embedded System (APRES) 


4. If you are registering as a student, please complete the following:

   Advisor's name:

   Advisor's e-mail address:

5. If you are an ACM or IEEE member, please complete the following:

   Membership number:

   Membership type (ACM or IEEE):

6. If you would like to pay extra page charges for an RTAS paper, please
   indicate how many pages you would like to pay for:

   RTAS pages (maximum 2 per paper, $100 each):

7. If you would like to purchase addditional tickets for the conference
   banquet, please indicate you many you wish to pay for:

   Extra banquet tickets ($100 each):

8. Please complete the following  information:

   Email address:

   Prefix (Dr., Prof. etc.):

   First Name: 

   Middle Name: 

   Last Name:

   Suffix:

   Title:

   Name as it would appear on a badge:

   Affiliation (University/Company/Organization):

   Address Line 1:

   Address Line 2:

   City:

   US State/Canadian Province:

   Int'l State/County/Province (Non US/Canada):

   Zip (Postal Code):

   Country:

   Phone:

   Fax:

   Cell Phone:

 
9. If you have any dietary restrictions, please indicate those here: