WOFE 2002 Registration Form
Please fill the form, print the filled form and mail with your check for $350 before October 1, 2001 and for $400 after October 1 to
Mr. George Narode, Electrical, Computer, and Systems Engineering, JEC, Rensselaer Polytechnic Institute, 110 8-th Street, Troy, New York 12180-3590, USA Tel: (518) 276-6071 Fax: (518) 276-6261 or participants may wire the registration fee to Rensselaer as follows:
Financial Institution: HSBC
Address: 126 State Street, Albany, NY 12207
Contact: Larry Schechter
Telephone No: 518-432-2030
Bank Acct No: 118-22717-3
A.B.A. Identifier: 021001088 Telegraphic Abbrev.: Marine-NYC
Purpose of Payment: WOFE-2002 and Participant Name
Attn: George Narode, Treasurer
Payment by a credit card
Circle one: Visa or Master card
Credit card number _____________________________________________
Expiration date _____________________________________________
Signature (required) _____________________________________________
Please circle one of the following statements
I am coming alone
I am bringing your spouse
I am bringing my spouse and __ children
First name
_______________ Last name _______________
Street address ____________________________________________________
City ____________________________________________________
State/Province ____________________________________________________
Zip/Postal Code ____________________ Country _________________________
Phone ____________________ Fax _________________________
E-mail ____________________________________________________
Affiliation ____________________________________________________