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 [ ]