IEEE/PES Insulated Conductors Committee

IEEE/PES***Presenters*** Insulated Conductors Committee Load your PowerPoint Presentations in Advance. FallSee Registration2004 MeetingDesk Registration Form

Last Name: ______First Name: ______Middle Initial:______First Name for Badge:______Guest Name Badge First: ______Last: ______Company:______Address: ______City: ______State/Province:______Postal Code: ______Country: ______Phone No: ______Fax No: ______Email: ______IEEE Member: Yes: ___ No: ___ Member No.* ______IEEE-SA Member: Yes: _____ No: _____ PES Member: Yes: ___ No: ___ Section Name ______ICC Member Classification:** Guest: ___ Member: ___ Voting Member: ___ Corresponding Member:____ Membership in IEC or other Organization (please specify): ______* If you do not provide your IEEE member number, you will pay the non-member rate. ** Procedures for requesting a change in classification are on the ICC website. ======Code Number Each Line Total US $ - MEETING REGISTRATION - Advance Registration & Minutes: IEEE Member ARM ______@ $165.00 US ______Advance Registration & Minutes: Non-IEEE Member ARN ______@ $175.00 US ______On-Site Registration & Minutes: IEEE Member ORM ______@ $185.00 US ______On-Site Registration & Minutes: Non-IEEE Member ORN ______@ $195.00 US ______Complimentary Registration1 CR ______No charge ______Guest/Companion Registration2 GR ______@ $20.00 ______Fall 04 Minutes3 FM ______@ $50.00 ______

1 Note: Complimentary registration for students, press, and retired (not working). Minutes are not included. 2 Note: Please register the number of spouses/guests/companions so we can properly plan. 3Note: The ICC Minutes are now included in the registration fee. Use this block to order extra minutes or if you are a corresponding member. Fall Minutes will be mailed out after the meeting. Previous minutes can be obtained from JMed & Associates, Ltd., E-mail: [email protected] , Phone: (847) 934-1154.

- EVENT REGISTRATION - October 31 Orientation Program ONP ______No charge ______October 31 Reception REC ______No charge ______November 2 Transnational Lunch TL ______@ $35.00 US ______November 3 Educational Program Lunch EDL ______@ $30.00 US ______November 3 Educational Program EDP ______No charge ______November 3 PDH Certificate CER ______No charge ______

- COMPANION ACTIVITY - November 1 Ladies Luncheon Activity ACT1 ______@ $30.00 ______November 2 Talent Fair – box lunch ACT2 ______@ $25.00 ______

Total Amount Enclosed: $US Funds Only: ______

Mail completed form and check to: Please make checks payable to ICC - Sorry, we cannot accept credit cards. Jim Fitzgerald The Okonite Company This form and/or payment must be RECEIVED by October 12, 2004. If not received by this date, payment must be made on site at on-site rates. 102 Hilltop Road Ramsey, NJ 07446 Fax: 201-327-0273 Attendees who have registered by e-mail, mail or fax by the above date e-mail: [email protected] may pay on-site at advance registration rates. Cash, checks, or travelers checks only in US$.