SAC 2004 REGISTRATION FORM
               August 9-10, 2004 Waterloo, Ontario, Canada

Surname: _________________________  Given Name: _______________________

Organization: _________________________________________________________

Address: ______________________________________________________________

____________________________________________ Postal Code: _____________

Phone: __________________ e-mail: _____________________________________

[ ] Check here if you do NOT want your contact information included in the
    workshop list of participants.

CONFERENCE REGISTRATION: (Please check the appropriate box.)
** You must be enrolled as a full-time student to receive student rate. **

[ ] Early Registration (by July 12):                    $300....$________
[ ] Late Registration (after July 12):                  $400....$________
[ ] Early Student Registration (by July 12):            $150....$________
[ ] Late Student Registration (after July 12):          $200....$________

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TOTAL AMOUNT PAYABLE:                                           $________
Notes: - The total amount must be paid upon registration.
       - A receipt will be issued for the registration amount only.

Method of Payment:[ ]Credit Card   [ ]Cheque in Canadian funds
                  (payable to "University of Waterloo")
                                                                   
Payment by Credit card (select one):    [ ]Visa     [ ]Mastercard

Name on Card: __________________________________________

Card Number:  ___________________________ Expiry Date: _____/_____(mo/yr)

Cardholder's signature: ________________________________

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Is a vegetarian meal required for the banquet?   YES ___    NO ___ 

Please indicate any other special dietary requirements:


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Mail or FAX this form to:	Attn: Janet Bullock, SAC 2004
				Dept of Elect & Comp Eng
				University of Waterloo, Waterloo, ON
				Canada N2L 3G1
				Fax:   +1 519 746 3077 
 				Phone: +1 519 888 4567 Ext. 5771