May 13, 2008 Chicago EMC MiniSymposium

Attendee Registration Form

Name            _______________________________
Company     _______________________________
Address       _______________________________
City               _____________ St_____ Zip________
Phone           ___ - ___ - _____ Fax ___ - ___ - ____
e-mail           __________________________________ 

Can we e-mail IEEE EMC Society meeting notices to you?  Yes ____  No ____

Registration fee (Includes lunch)   
Special meal / needs____________________________
IEEE Membership number (all grades) _______________     $35           _____
IEEE Non-member                                                                            $45            _____
Student ID Number__________ University______________ $15           _____
or  Students free after 12:40PM

Payment by Credit card
Type________   Number ___________________________ Exp ____ Bank____________
Name and mailing address as on credit card
________________________
________________________
________________________
________________________
Signature (required) __________________________ Date ___________
Fax completed application to Ray Klouda, at 630-495-9785

Payment by check           
Make check payable to:  IEEE EMC Society

Please advise by emailing frank@electronicinstrument.com and bring check to the MiniSymsposium.  Thank you.