CRYPTO 2003

August 17-21, 2003
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 2003, send this completed form with payment to:

Crypto 2003 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.

All amounts are specified (and must be paid) in US$.

We highly recommend that you fill out this form on the screen, then print it. Note that this is not online registration: there is no "submit" button!

Personal Information

IACR member #:

(if you know it)

Name:

Affiliation:

Address:





Phone:

Fax:

Email:

URL:

Conference Registration (choose a, b, or c)

a.

Full Time Student

$255

b.

Attended earlier IACR conference or workshop in 2003

$492

c.

Regular Registration Fee

$580

IF YOUR REGISTRATION IS POSTED AFTER JULY 14, 2003 - ADD $95 late fee

Room

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

Single Room

$295

Double Room

$230 per person
Roommate's Name:

Double Room for attendee and guest

$460
(optional) Roommate's Name:

Saturday Night (incl. dinner
and breakfast)


$75 per person single
$60 per person double

Thursday Night (incl. dinner
and breakfast)


$85 per person single
$70 per person double

Gender

 

(only used for room allocation)

 

Guest

Extra Guest for Social Events only: $180 per person. Number of guests:

Guest's Name(s):

Total and payment

TOTAL AMOUNT 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, and note that the form MUST BE SIGNED BY HAND.

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