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Please print out and send separate forms for each attendee.

IEEE International Workshop On Embedded Fault-Tolerant Systems
May 22-23, 1998, Boston University, Boston, MA

Please print or type

Registrant Information

Name: ________________________________________________________________________
      Last                          First             Middle

Title (circle one): Prof., Dr., Mr., Ms., Mrs.

Affiliation: _________________________________________________________________

Mailing Address: _____________________________________________________________
                 City                     State         Zip        Country

Telephone: _______________________________ Fax: ______________________________

Email: _______________________________________________________________________

Do you have any special needs?: ______________________________________________

Conference Registration

Advance (before May 8, 1998)       Late/On-Site (after May 8, 1998)

  ___ IEEE Member  US$220.00           ___ IEEE Member  US$265.00
  ___ Non-member   US$285.00           ___ Non-member   US$330.00
  ___ Student      US$100.00           ___ Student      US$100.00




Registration Fee:   Workshop: _______________________


              Total Enclosed: _______________________	

Mail registration form with payment to: Volker Strumpen, MIT Lab for Computer Science, 545 Technology Square NE43-218A, Cambridge, MA 02139, Phone: (617) 253-1531, FAX: (617) 253-0415, Email: strumpen@theory.lcs.mit.edu.

Method of Payment

___ Company Check    ___ Travelers Check   ___ Purchase Order