2006 IEEE Dallas ETC
September 15, 2006 - Holiday Inn Select, Richardson, Texas
http://ieee-etc.org

Registration Form
(Please Print)

____________________________________________________________________
Name

____________________________________________________________________
Company/Organization

____________________________________________________________________
Address

____________________________________________________________________
City/State/Country/Zip Code

____________________________________________________________________
Daytime Phone (very important)                  Facsimile

____________________________________________________________________
EMail


Package Selection

[ ] Conference Package, Early Registration (by 8/31/06) ($100)

[ ] Conference Package, Early Registration (by 8/31/06) ($35)
    Student/IEEE Life Member

[ ] Conference Package ($125, after 31/8/06)

Payment Method

Total Amount of Order   $________________


[ ] Check enclosed      [ ] Visa  [ ] Master Card  [ ] AMEX  [ ] Discover

___________________________________________________________________________
Credit Card Number                      Exp. Date               CVV Code*
CVV Code (3 or 4 digits, usually on back of card)

________________________________________________________
Name on Card (if different than above)

________________________________________________________
IEEE Member Number (if applicable)


Notes

- Conference package includes technical sessions, lunch,
  refreshments, reception and conference digest.

- Please makes checks payable to IEEE.

- Fax registration form to:     Sam Broyles @ 214 480 2264

- Mail registration form to:    IEEE ETC 2006
         c/o Sam Broyles
         Texas Instruments
         12500 TI Blvd., MS 8701
         Dallas, Texas 75243

- For additional information please contact Sam Broyles @ 214 480 3232 or
  send email to sam.broyles@ti.com.