Registration Form for FOCS 2000

Name:
Affiliation:

Address:

E-mail:
Phone:
Dietary restrictions: Kosher / Vegetarian / None
Affiliation, as it should appear on the badge:

Please circle one category below and fill in your membership number if appropriate: #

 Registration fees until 10/19 after 10/19
 ACM, SIGACT, IEEE    
 or EATCS member 330 390
 Author 330 390
 Student 110 130
  Other 420 480

Machtey Fund contribution:

Total registration:

To pay by Visa, Mastercard or Discover, provide the name that appears on the card, the billing address of this card, and the signature of the card holder.

Name:
Address:

Card Type:
Card Number:
Expiration Date:

Signature:

I agree to pay the above total amount according to card issuer agreement.

Send to: Joyce Akhtarkhavari, Attn: FOCS 2000, Department of Computer Science, University of California, Riverside, CA 92521. Fax: 909-787-4643.