Credit Card Type ______ Master Card ______ Visa ______ Discover Card
Card Number ___________________________ Expiration Date _________________
Cardholder's Name ______________________________________________________
Signature ______________________________________________________________
Billing Address _________________________________________________________
Name (as will appear on nametag) _______________________
Affiliation __________________________________________
Address ___________________________________________
Please check if ____ work or ____ home
City _________________________ State _____ ZIP ________
Phone __________________ e-mail _______________________
| ========= On or before February 5th, 2003 ==================== | ||
| ____ | Interface Foundation of North America (IFNA) Membership | $35 |
| ____ | Interface Registration (for long-term IFNA Members) | $200 |
| ____ | Interface Registration (for IFNA Members) | $215 |
| ____ | Interface Registration (for Members of Cooperating Societies - see list below) | $250 |
| ____ | Interface Registration (for Full-time Students) | $110 |
| ____ | Interface Registration (all others) | $295 |
| ____ | Registration for a Single Day of Interface (No Banquet, no CD) | $130 |
| | ||
| ========= After February 5th, 2003 ======================== | ||
| ____ | Interface Foundation of North America (IFNA) Membership | $35 |
| ____ | Interface Registration (for long-term IFNA Members) | $250 |
| ____ | Interface Registration (for IFNA Members) | $265 |
| ____ | Interface Registration (for Members of Cooperating Societies - see list below) | $300 |
| ____ | Interface Registration (for Full-time Students) | $150 |
| ____ | Interface Registration (all others) | $350 |
| ____ | Registration for a Single Day of Interface (No Banquet, no CD) | $150 |
| | ||
| =============================================== | ||
| ____ | Banquet (for Single Day Registrants or Guests) | $50 |
| | ||
| ========= Short Courses: On or before February 5th, 2003 ============ | ||
| David Marchette, Statistical Methods in Computer Security | ||
| ____ | Computer Security (IFNA/Cooperating Societies Member) | $165 |
| ____ | Computer Security (Non-IFNA/Cooperating Societies Member) | $225 |
| ____ | Computer Security (Full-Time Student) | $75 |
| Jeffrey L. Solka, Topics in Computational Statistics with MATLAB | ||
| ____ | Comp. Stat. with MATLAB (IFNA/Cooperating Societies Member) | $165 |
| ____ | Comp. Stat. with MATLAB (Non-IFNA/Cooperating Societies Member) | $225 |
| ____ | Comp. Stat. with MATLAB (Full-Time Student) | $75 |
| Both Courses | ||
| ____ | Both Courses (IFNA/Cooperating Societies Member) | $225 |
| ____ | Both Courses (Non-IFNA/Cooperating Societies Member) | $350 |
| ____ | Both Courses (Full-Time Student) | $100 |
| | ||
| ========= Short Courses: After February 5th, 2003 ================ | ||
| ____ | Late fee for short courses after 2/5/03 or when upgrading from 1 to 2 short courses | $30 |
| | ||
| _____ | TOTAL | $_____ |