Registration Form

The 100% Pure 802.11 Event

October 2-3, 2002
The Pan Pacific Hotel, Singapore

Registration Form

The amount we will charge to your credit card is: (circle preference)
On or before September 18
Full Pass (October 2-3) -- S$995 per person (US$570)
One day (Oct 2 OR 3) -- S$595 per person (US$340)
Full Pass Group Rate for 3 or more people -- S$895 per person (US$510)
One Day Pass (Oct 2 or 3) Group Rate for 3 or more people -- S$545 per person (US$310)

After September 18
Full Pass (October 2-3) -- S$1,195 per person (US$685)
One day (Oct 2 OR 3) -- S$695 per person (US$400)
Full Pass Group Rate for 3 or more people -- S$895 per person (US$510)
One Day Pass (Oct 2 or 3) Group Rate for 3 or more people -- S$545 per person (US$310)

Please complete the form below. After typing information,
print this form and mail or fax with payment to the address below.

YOUR INFORMATION
First Name:
Last Name:
Title:
Position:
Company Name:
Street Address:
City:
State (U.S.) or Canada:
Province:
Zip/Postal Code:
Country:
E-mail Address:
Providing your e-mail address to us indicates that you may be interested in receiving future e-mail promotions about other INTM events. Check to opt-out*
Telephone:
Fax:

PAYMENT INFORMATION
Credit Card Holder's Name:
*Credit Card Type:
Credit Card Number:
Month card expires:
Year card expires:
Cancellations and Substitutions We welcome a substitute delegate to take your place should you not be able to attend at the last minute. However, we regret that there will be no refunds for cancellations and no-shows. For inquiries send e-mail to Serene Tay at stay@jupitermedia.com. Please Note: Jupitermedia Corporation reserves the right to make changes to the events program. Unforeseen circumstances may result in the substitution of a presentation, topic or speaker. You consent to INTM recording and/or photographing the event and using such items, including your likeness, in future promotions. Jupitermedia Corporation reserves the right to reject or rescind any registration and return any fees accordingly. Registrant assumes all risks incidental to participation in all event activities, including loss or damage to property. Jupitermedia Corporation's total liability shall be limited to the amount of fees received, if any, from a particular registrant.
How did you hear about us?:
If other:

Mail your completed registration form with payment to (checks payable to Jupitermedia Corporation):

Asia.Internet.Com LLC
Att: 802.11 Planet Conference
50B Tras Street
Singapore 078989

You may also fax it WITH CREDIT CARD PAYMENT to (+65) 6274 8913 - ATTN: Serene Tay.

NOTE: REGISTRATION FORM AND PAYMENT MUST BE RECEIVED TOGETHER TO BE PROCESSED.