Passive and Active Measurement Workshop (PAM)
Boston, March 30-April 1 2005
Registration form
Early registration deadline : March 1st


To fill in, print and send by fax or surface mail to
Ellen Grady
Computer Science Department
Boston University
111 Cummington St.
Boston MA 02215
Tel : + 1 617 353 8919,    Fax : + 1 617 353 6457
PARTICIPANT  INFORMATION
Name First name
Affiliation
Address

City Zip code
Country State
Phone Fax
Email

Registration fees
Early Registration (before March 1st)
Select your category
Student USD 225                               
Non-Student USD 250
Late Registration (after March 1st)
Student USD 275
Non-Student USD 300

The fees include two lunches, the coffee breaks, Thursday dinner and the welcome reception on Wednesday evening.
Student registrations must be accompanied by a copy of a student ID card, valid at the time of the workshop.

Cancellation :
Registration fees can be refunded on written demand to the above address before March 15

METHOD OF PAYMENT

- By check in US Dollars, the check MUST be made payable to: "PAM 2005/Boston University"
- By credit card (VISA, MASTERCARD or DISCOVER)
by filling and signing the following form

Personal data : Last name First name
I authorize Boston University to charge my credit card
Card type Amount
Card number Expiration date

Date
Signature

Do you have a special meal requirement ?

To complete your registration
1) print the form
2) date and sign (if you pay by credit card)
3) send the printed form by fax OR regular mail to Ellen Grady at the address on the top. 
Don't forget to include a copy of your student card if you are registering as a student.
In case of problem, send an e-mail to Ellen Grady