Carrissa Bryant,

EWOFS 2016 REGISTRATION FORM
Name:
Affiliation:
E-Mail Address:
Phone:
Mailing Address:
City:
Mailing State/Province:
Country:
Mailing Postal Code:
Member Number (IEEE, SPIE, OSA, EOS):
Are you an author?
No Are you a Student?
Yes
Yes
If so:
No
Graduate
Undergraduate
If you are an author, list your four-digit paper number(s):
Dietary Restrictions:
I would like to participate in the Thomond Park Stadium Tour:
Circle the items you wish to register for:
Items
Purchased
Member
Conference
Registration
Up to
Ɖƌŝů30,
2016
After Ɖƌŝů
30, 2016
€600
€700
Non-Member
Up to Ɖƌŝů
30, 2016
€650
After Ɖƌŝů
30, 2016
€750
Student Member
Up to Ɖƌŝů
30, 2016
€450
After Ɖƌŝů
30, 2016
€550
Student Non-Member
Up to
Ɖƌŝů30,
2016
After
April 30,
2016
€500
€600
Extra Items
Full Conference Registration includes access to all Workshop Sessions, Conference Proceedings, lunches
and coffee breaks, the Welcome Cocktail, and the Gala Dinner. Please select the items below only if you
wish to purchase additional items. Guest registration includes the Welcome Cocktail and the Gala
Dinner.
Extra
Conference
€90
€90
Proceedings
Accompanying
€200
€200
Person
Total
Payment Method: Credit Card (Visa, MasterCard), Check, or Wire Transfer
CC #:
Exp. Date:
CCV (reverse side of card):
Subtotal
$
Subtotal
$
$