CONFERENCE REGISTRATION FORM
Thirteenth IEEE International Vacuum Electronics Conference (IVEC) and
Ninth International Vacuum Electron Sources Conference (IVESC)
 Portola Plaza Hotel, Monterey, CA, April 24-26, 2012


Dr./Mr./Ms.
First Name
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Informal First Name, as you would like it to appear on the badge

Company or Affiliation

Address

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State or Province
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Phone
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$550 *Advance Registration (before April 6) - IEEE Members ($575 Late or On Site)
$625 *Advance Registration (before April 6) - Non-Members ($650 Late or On Site)
$275 *Retired/IEEE Life Members
$100 * Full-time Students (proof of full-time student status will be required)
Additional Wednesday Evening Dinner and Entertainment Tickets @ $60 PER TICKET
Additional USB @ $30
* All registration categories include one Wednesday Dinner ticket and one USB Book of Abstracts
CREDIT CARD: VISA MasterCard AMEX Diner's Club
Card Number: Expiration Date (mm/yyyy):
  /
Please note that IVEC credit card charges will appear as Palisades Convention Management on your credit card statement.

Return to the IVEC 2012 web site WITHOUT registering

Forms with credit card payment may be faxed to (212) 460-5460 or mail form to:

Mr. Mark Goldfarb, IVEC/IVESC
c/o Palisades Convention Management
411 Lafayette Street, Suite 201
New York, NY 10003
(212) 460-9700 or (800) 350-0111, [email protected]

Confirmations will be mailed. Cancellations will not be accepted after April 6, 2012.