~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ INET'95 ISOC SCHOOL NETWORKING COLLOQUIUM REGISTRATION ISOC School Networking Colloquium 1-Day Pre-conference Honolulu, Hawaii, USA 26 June 1995 ----------------------------------------------------------------------------- ISOC SCHOOL NETWORKING COLLOQUIUM REGISTRATION TEMPLATE The easiest and best way to register for the conference is via our WWW INET95 ISOC School Networking Colloquium form at http://www.isoc.org/ISOC_School_Networking.html We appreciate your use of the WWW form. If you do not have access to the WWW or don't wish to use it, please return the following template: 1) by email to or 2) by FAX to: +1-703-648-9887 or 3) by postal mail to Internet Society 12020 Sunrise Vly Dr, Suite 270 Reston VA 22091 USA INTERNET SOCIETY Mr ____ Ms ____ Mrs ____ Dr ___ Prof ___ Dip Ing ___ FIRST NAME: __________________________________________________ INITIAL/MIDDLE NAME: __________________________________________________ FAMILY (LAST) NAME: __________________________________________________ SUFFIX : __________ TITLE: ___________________________________ AFFILIATION: ______________________________________ ADDRESS: ___________________________________ ___________________________________ CITY: _________________ STATE/PROV: ______ POSTAL CODE: _______ COUNTRY: _______________ WORK TELEPHONE: _____________________ (optional) HOME TELEPHONE: _____________________ (optional) FAX: _____________________ (optional) EMAIL: ________________________________ ----------------------------------------------------------------------------- COLLOQUIUM PAYMENT REGISTRATION FEES: Before 26 May 1995 After 26 May 1995 $95 $105 TOTAL AMOUNT: US$ _____________ How do you wish to pay? ___ Credit Card ___ VISA ___ MasterCard ___ AmEx Card Number _________________ Expiration Date _____________ Name on Card __________________________ Signature (for faxes or postal mail) _________________________________ ___ Wire Transfer: Riggs Bank of Virginia Bank ABA number: 056001260 8315 Lee Highway Account number: Internet Society 148 187 10 Fairfax VA 22031 USA >>Please Indicate your name on the wire transfer ___ Personal Cheque, Bank Draft, or money order (for postal submissions) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~