Registration Form - ACCV'98 Third Asian Conference on Computer Vision Hong Kong, January 8-10, 1998 Surname:_______________ First name:_______________________ Title:_____________ Organization/Institution:_____________________________________________________ Address:______________________________________________________________________ ______________________________________________________________________ Phone:___________________ Fax:_____________________ E-mail:___________________ Conference fee (please check the appropriate box): After Dec. 1,1997 IEEE-Member*(without banquet) [ ] HK$ 2,400 (US$ 310) IEEE-Member*(with banquet) [ ] HK$ 2,800 (US$ 360) Non-Member (without banquet) [ ] HK$ 2,800 (US$ 360) Non-Member (with banquet) [ ] HK$ 3,200 (US$ 410) Student** [ ] HK$ 1,400 (US$ 180) *IEEE membership number: ______________________________ **Student fee does not include conference reception and banquet. To receive the student rate, students are required to obtain his/her advisor's signature: Advisor's name:________________________ Signature:____________________________ Conference fee includes admission to the conference, a copy of proceedings, coffee breaks, cocktail reception. A conference banquet will be held in the evening on January 9, 1997. Extra banquet ticket [ ] Number of tickets ______ x HK$ 500(US $65) Total payment: _________________________________ Please return this form together with payment to (Mail/Fax): ACCV'98 Department of Computer Science HK University of Science & Technology Clear Water Bay, Kowloon Hong Kong Tel. No: +852 2358-7003, Fax: +852 2358-1477 _____________________________________________________________________________ Method of payment: (I) Telegraphic Transfer The amount can be wired to the following bank and account Bank name: Hang Seng Bank Limited Branch: Head Office Bank Account no.: 024-262-324999-001 Bank Account Name: The Hong Kong University of Science and Technology Bank Address: Hang Seng Bank Limited Head Office 83 Des Voeux Road Central, Hong Kong Please ensure to provide us with the following information, so that we can identify the payment precisely. 1. Name of the registrant 2. Amount credit to our bank account 3. Date of making the telegraphic transfer payment 4. Nature of the payment, i.e. registration fee for ACCV conference Note: Service Charge should be on application's account (II) Payment by credit card (*delete where inappropriate) Please debit the *Visa/Master/AmericanExpress card the total amount of *HK$/US$:______________________________ Card No.:________________________________ Expiry Date:______________________________ Card Holder Name:______________________________(in block letters) Signature:_________________________________ Please state the name of registrant(s) if it is different from the card holder (III) Payment by money order or bank draft (by Post): Payable to the Hong Kong University of Science and Technology Please return this form together with payment to (by Post/Fax): ACCV'98 Department of Computer Science HK University of Science and Technology Clear Water Bay, Kowloon Hong Kong Tel. No: +852 2358-7003, Fax: +852 2358-1477