Please complete the registration form and either e-mail it to
ciaa2003@cs.ucsb.edu (with subject line "CIAA 2003 Registration")
or FAX it to Prof. Tevfik Bultan at the following number:
+1-805-893-8553

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CIAA 2003 REGISTRATION FORM


First Name:  __________________________________________________________


Last Name:   __________________________________________________________


Affiliation: __________________________________________________________


Email:       __________________________________________________________


Street Address: _______________________________________________________


City: _____________________________  State/Province: __________________


Zip/Postal Code: __________________  Country: _________________________


Telephone: ________________________  FAX: _____________________________


Dietary Restrictions:  Vegetarian  Other (specify): ___________________


Registration Fees 

    Registration (check one)      ___ Regular $265   ___ Student $150

    Extra tickets for reception   ___ x $25

    Extra tickets for banquet     ___ x $40

    Total:                       $_________


Payment Method (check one): ___ Check 

                            ___ Cash 

                            ___ Credit Card 


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