To register, print and mail the following form: --------------------------------------------------------------------- CRYPTO '97 Registration Form Registration deadline: July 12, 1997 Last Name: ________________________________________________________ First Name: ____________________________________ Sex: M or F _______ Affiliation: _______________________________________________________ Mailing Address: ___________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Phone: ___________________________ Fax: ____________________________ Electronic Mail: ___________________________________________________ ___ Check here if you wish to have your name and address excluded from the list of delegates. ___ Check here if you with to have your name and address excluded from the IACR membership listing. Payment of the conference fee entitles you to membership in the International Association for Cryptologic Research for 1998 at no extra charge, including a subscription to the Journal of Cryptology, published by Springer-Verlag, at no extra charge. Do you wish to be an IACR member? ___ YES ___ NO Conference Registration Fee (check first line that applies): Paid by July 12 After July 12 ___ Full-Time Student $211 $291 ___ Attended Eurocrypt '97 $350 $430 ___ Regular Registration $422 $502 $ _________ ___ Guest Attendance (social program only) $60 Guest's Name________________________ $ _________ Room Sunday to Thursday (non-smoking) with breakfast and lunch Monday through Thursday ___ Single room $290 ___ Double room $230 Roommate's name: _____________________ $ _________ Extra nights at $70 single, $55 double, per person, per night ___ Saturday night $ _____ ___ Thursday night $ _____ $ _________ TOTAL ENCLOSED OR PAID BY CREDIT CARD: $ _________ Enclosed payments must be in U.S. funds: by check drawn on a U.S. bank, by U.S. money order, or by U.S. bank draft, payable to CRYPTO '97. Credit card payments are accepted by either mail or fax. Check one: __ VISA ___ MasterCard ___ American Express Name on card: ___________________________________________ Card number: ___________________________ Expires: ______ Cardholder's signature: _________________________________ Send forms and enclosed payments to: For more information: Bruce Schneier, Crypto '97 Email: crypto97@iacr.org Counterpane Systems WWW: http://www.iacr.org 101 E Minnehaha Parkway Phone: +1 612 823 1998 Minneapolis, MN 55419 USA Fax: +1 612 823 1590