CRYPTO '98 Registration Form

Registration Deadline: July 16, 1998

Last Name: _______________________________________________________________________

First Name: _______________________________________________________ Sex: M or F _____

Affiliation: _______________________________________________________________________

Mailing Address: __________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Phone: _______________________________ Fax: _______________________________________

Electronic Mail: ___________________________________________________________________

___ Check here to exclude your name and address from the list of delegates.

Conference fee includes membership in the International Association for Cryptologic Research for
1999 at no extra charge, including a subscription to the Journal of Cryptology, published by Springer-Verlag.

Do you wish to be an IACR member? ___ YES ___ NO

___ Check here if you want your name and address excluded from the IACR membership listing.

Please list any special needs, including dietary: ___________________________________________

_________________________________________________________________________________

Conference Registration Fee (check first line that applies):
Paid by July 16 After July 16
____Full-Time Student
$220
$295
____Attended Eurocrypt '98
$358
$433
____Regular Registration
$430
$505
$ ____________
____Guest Attendance
$120
$120
(social program only) $ ____________

Guest's Name: ______________________________________________

Room Sun. to Thurs. (non-smoking) with breakfast and lunch Mon. through Thurs.

___ Single room $231___ Double room $176 $ ____________

Roommate's name: ______________________________________________

Extra nights at $68 single, $54 double, per person, per night

___ Saturday night $ _____
___ Thursday night $ _____ $ ____________

If you are staying in one of the Goleta hotels (Pacifica Suites, Holiday Inn, or Best
Western South Coast Inn), would you be interested in using a shuttle bus to and
from the conference?

YES ___ NO ___

If you are staying off campus, will you need a parking pass?

YES ___ NO ___

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 U.C. Regents

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:
Campus Conference Services-Crypto
Santa Rosa Hall
University of California
Santa Barbara, CA 93106-6120

Or by Fax to: +1 805-893-7287

Or by e-mail to: svito@housing.ucsb.edu

For more information:
Email: crypto98@iacr.org
WWW: http://www.iacr.org
Phone: +1 805-893-3072