CRYPTO 2001

August 19-23, 2001
Santa Barbara, California, USA

R E G I S T R A T I O N   F O R M

Instructions: To register for Crypto 2001, send this completed form with payment to:

Crypto 2001 Conference
Campus Conference Services
University of California
Santa Barbara, CA 93106-6120
USA

If paying by credit card, the completed form can be faxed to +1 (805) 893-7287. We cannot accept registration by email.

Personal Information

Name:


______________________________________________________________

Affiliation:


______________________________________________________________

Address:


______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

Phone:


______________________________________________________________

Fax:


______________________________________________________________

Email:


______________________________________________________________

URL:


______________________________________________________________

Sex:


______________________________________________________________

Conference Registration (choose a, b, or c)

a.

Full Time Student

$235

[     ]

b.

Attended Eurocrypt 2001 (Austria)

$465

[     ]

c.

Regular Registration Fee

$545

[     ]

IF YOUR REGISTRATION IS POSTED AFTER JULY 15, 2001 - ADD $85 [     ]

Room

Room (no smoking, 4 Nights, Sun. through Wed.) and Board (breakfast and lunch Mon. through Thu.):

Single Room

$264

[     ]

Double Room

$204 per person
(Optional: Roommate's Name: _________________________________)

[     ]

Saturday Night

$67 per person single
$52 per person double

[     ]
[     ]

Thursday Night

$75 per person single
$60 per person double

[     ]
[     ]

Guest

Extra Guest for Social Events only: $150 per person [      ]

Guest's Name: ____________________________________________________

IF YOUR EXTRA GUEST FEE IS POSTED AFTER JULY 15, 2001 - ADD $85 [      ]

Total and payment

TOTAL FUNDS DUE (US Dollars): $________________

Payment - We accept checks IN US DOLLARS DRAWN ON A US BANK made payable to "U.C. Regents", or credit cards. You MUST include your payment in full when you return this form. If you choose to pay by credit card, complete the following.

Card Type:


American Express [      ]
Visa [      ]
MasterCard [      ]

Card Number:


______________________________________________________________

Expiration Date:


______________________________________________________________

Name on Card:


______________________________________________________________

Cardholder's signature:


______________________________________________________________

IACR Membership and Privacy

When you register and pay for Crypto you will automatically become a member of IACR for next calendar year free of charge. As a member next year you will receive the IACR (email) Newsletter and The Journal of Cryptology. If you do NOT want to be a member next year, and do NOT want to receive the Journal or Newsletter, choose this box:

I DO NOT WISH TO BE AN I.A.C.R. MEMBER [      ]

Personal Information - The personal contact information that you provide is maintained in the IACR Membership Database and will be published in the conference attendee list and the IACR Membership List that is sent to all members every year. It is NOT made available to any other organisation in electronic form. If you do NOT want your contact information to be published in the conference attendee list and the IACR Membership List, choose this box:

I DO NOT WANT MY DETAILS PUBLISHED [      ]