Industry-University Symposium on Electrical Engineering (IUSEE)

November 14, 2003

CIAPR

San Juan, Puerto Rico

http://iie.ciapr.org

IUSEE 2003 Registration Form

Name:______________________________

PE Lic. #:______ EIT Certif. #:______

Company:___________________________

Address:____________________________

___________________________________

___________________________________

Email:______________________________

Daytime Phone No.____________________

Alternate Phone No.___________________

Participant registration $_______

November 7	Early registration (must include the IIE Survey ): $45
November 14	Registration deadline: $50 Companies with 3 or more attendants: $45 per person

PARTICIPANT Refund policy: The last day to request a partial refund (50%) is NOVEMBER 7, 2003 (allow up to 8 weeks for credit). Refund requests must be made via certified mail. There is a $25 non-refundable fee for each registration.

NO REFUNDS, under any circumstance, after November 7, 2003

Check or Money Order # _____

(Payable to CIAPR - IIE)

Credit Card: ___Visa ___Master Card

Card #:______________________________

Name on Card: _______________________

Expiration date: ______________

Signature____________________________

Send participant registration form, along with the IIE Education & Workforce Survey (available at http://iie.ciapr.org) to: Educación Continuada (CIAPR) via fax: 787-765-7075 or mail to:

CIAPR-IIE

Attn: Educación Continuada

P.O. Box 363845

San Juan, PR 00936-3845

IUSEE Information

http:// iie.ciapr.org

Colegio de Ingenieros y Agrimensores de PR

Instituto de Ingenieros Electricistas (IIE)

Email: iie@ciapr.org, oneill@ieee.org

Office use only:

Processed by:____________________________

Date:________________________________