PKC 2004

2004 International Workshop on Practice and Theory
in Public Key Cryptography

1-4 March, 2004, Sentosa, Singapore



REGISTRATION FORM

Name (first, middle, last): __________________________________________________________________________

Affiliation (for badge): ____________________________________________________________________________

Title/Job Function: _______________________________________________________________________________

Address: _______________________________________________________________________________________

City: _____________________  State/Province: ________________  Zip/Postal Code: ___________________

Country: __________________________ Email: _______________________________________________________

Phone: (____)___________________________ Fax: (_____)_____________________________________________

IACR Member ID: ___________________________________  Student ID: _________________________________

Special Needs:___________________   Special Dietary Requirements:    Vegetarian    Kosher     Vegan

Paper No. and Title: ______________________________________________________________________________

Do not include my name, address and e-mail id in the conference attendee listing ____.

REGISTRATION FEES (inclusive of taxes)
Please circle appropriate fees.

Attended FSE2004: 			US$490.00

Did not Attend FSE2004: 		US$580.00

Student and Attended FSE2004: 		US$290.00

Student, but did not Attend FSE2004:	US$335.00


Note: 
1. As PKC is an IACR workshop, the attendee of PKC workshop is to become automatically members of 
   the IACR, and hence is required to pay membership dues unless attending FSE¡¯04.
2. Students must provide by fax or mail a current ID card, or a letter from their department 
   confirming their full-time status.

The Conference Registration includes attendance at all conference sessions on March 1 through March 4; 
Conference Lunches, and refreshment breaks on those days; the Welcome Reception; the Conference Banquet; 
and one copy of the Conference Proceedings.

Total Fees: US $ _______________________ (Make checks payable to Institute for Infocomm Research)

Payment included (circle one):   Master Card      Visa         Check

Credit Card Number: ___________________________________ Expiration Date: __________________

Name as it appears on Credit Card: ________________________________________________________

Signature: ____________________________________________________________________________


For Registration by Fax:
	(65) 6775-5014, Attention: Dr. BAO Feng. PKC 2004 Conference

For Registration by Mail (include check and registration form):
	Attention:  Dr. BAO Feng 
	PKC 2004 Conference
	21 Heng Hui Keng Terrace
	Singapore 119613

For questions (9:30 AM - 5:30 PM SGT), 
	Telephone: (65) 6874-8456,  6874-8543.
	Email: pkc2004@i2r.a-star.edu.sg 

You should receive e-mail confirmation once your order is processed.  If you do not, 
please contact the PKC Member Services Department at the above contact information.