Sponsorship Particitpation Form
INET 97 Registration Form

This form allows you easily to register for the INET 97 conference. Please note that this page only works if your browser supports forms. This form must be completed for each person attending the conference.

If you cannot or do not want to use this form, you may alternatively print out this document and mail it to INET'97, 12020 Sunrise Valley Drive, Suite 210, Reston, VA, 20191-3429, U.S.A., fax it to +1.703.648.9887, or email the information to inet97@isoc.org to confirm your participation.


Primary Registrant: Family/Last: First: Middle: Name as it should appear on badge: ISOC Member Number (optional): Title: Organization: Mailing Address: City: State or Province: Postal Code: Country: Telephone Number: (please include country code) Fax Number: Email address: Accompanying Person/Guest (if registering) Family/Last: First: Middle: Name as it should appear on badge: Address: City: State: Postal Code: Country:
Registration Fees
                               On or Before May 12 1997     After May 12 1997
INET 97:  Internet Society Member        $445                $545
          Non-Internet Society Member *  $495                $595
          Accompanying Person/Guest      $200                $200
Pre-Conference:
          K-12 Workshop                  $ 95                $105
          Tutorials                      $175 each           $195 each
               (Detailed information will be available March 1, 1997)
                           Primary Registrant   Guest   
               Tutorial 1                     
               Tutorial 2                     
               Tutorial 3                     

               Tutorial 4                     
               Tutorial 5                     
               Tutorial 6                     

          African Networking Symposium   $ 95                $105       

TOTAL AMOUNT DUE                  U.S. $
(Payments must be in U.S. Dollars)
* The Non-Internet Society Member registration fee includes a one year membership to ISOC. Membership begins the first day of the month after payment is received.


Payment Method:

  1. Personal Check (For postal submissions only)

  2. Credit Card.
          Mastercard
          Visa
          American Express
         Credit Card Number: 
    
         For credit cards only:
             Expiration Date:    
             Name on Card:       
             Do we have your authorization to charge the indicated total 
             against your card number?  (Type YES) 


  3. Wire Transfer
       Riggs Bank of Virginia    ABA number: 054000030
       950 Herndon Parkway       Account Number: Internet Society 14 838 710
       Herndon, VA  20171
       USA
        Please indicate your name on the wire transfer
    

  4. CyberCash Secure Payment Service (For webpage form only)
      The Cybercash Secure Payment System will encrypt your financial credit
      card information for private transmission over the Internet. To make use
      of Cybercash, you will need to download a free wallet.

     Note: We do not accept purchase orders as payment for registration fees.

     Mail, with payment, to: INET 97
                             12020 Sunrise Valley Drive, Suite 210
                             Reston, VA, 20191-3429
                             USA 
     Fax to:                 +1 703 648 9887
     E-mail to:              inet97@isoc.org


Cancellation Policy

All cancellations must be submitted in writing or e-mail. No cancellations after June 13, 1997. A $110 cancellation fee will be charged for conference cancellations received through June 13, 1997. Substitutions are permitted from the same institution for conference registrations.

Statistical Information
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