IEEE 802.16 Session #21 Registration Form

Use this form to register for Session #21.

(1) Provide information about yourself, using (a), (b), (c), or (d):

(a) I am an 802.16 Member:

(b) I am an 802.16 Observer:

(c) I am another recent attendee:

(d) I am not listed above. If you choose (a), (b), or (c), then please do NOT complete (d)!

Last (Family) Name:
First (Given) Name:
Company/Organization:
Department: Title:
Address Line 1:
Address Line 2:
City:
(USA/Canada only)    Other District:
Country: Postal Code:
Telephone: Fax: E-Mail:

(2) Select the action you wish to take:

Register for Session #21. The preregistration deadline past, but you are still encouraged to submit this form if you plan to attend. Your registration fee will be payable on-site by credit card or cash. Please cancel your registration immediately if your plans change!
Cancel registration for Session #21.

(3) Please answer the following:


Do you plan to stay at the Shilla Cheju Hotel?No Yes. {If so, you should reserve a room immediately}.

Will you attend the Wednesday social hosted by Samsung? No Yes

(4) Comments:

Confidentiality:

Your name and company may be posted on the publicly-available web site. It is 802.16 policy to keep your contact information confidential; it may be posted to the password-protected 802.16 site.

Upon submission, you should receive the message "Your form input has been noted. Thank you!"

To confirm your registration, see the preregistration list. Please allow time for the list to be manually updated.

Updated: 1 September 2002

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