MeshForum 2006 Registration Form
The 2006 MeshForum event is expected to happen on 7-9 May 2006 in Chicago.
Attendee Information (please fill out for each attendee)
Full Name: _________________________
Name on badge: ____________________
Title: _____________________________
Affiliation: _________________________
Mailing Address:
__________________________________
__________________________________
__________________________________
__________________________________
Contact Phone: _____________________
eMail Address: ______________________
Are you interested in being on a panel or being a session leader at MeshForum?: ___
What area(s) of Networks interest you?:
In what area(s) of Networks are you an expert? (cite examples, publications, etc if you like):
Blurb / Bio (Please include anything you would like to have potentially listed in the program book with your name and affiliation. URL's, Book Title, etc. are welcome.)
Registration Details
Early Pre-registration: $500.Number of attendees registering: ______
Total enclosed: _______
Checks or Money Orders should be made out to MeshForum
Please mail completed form and registration fee to
MeshForum
attn. Shannon Clark
333 W. North Ave, #160
Chicago, IL 60610
Or you may email the information to shannon AT meshforum.org and pay via PayPal.