South Asian Network Operators Group IV
23-30 July, 2004, Kathmandu, Nepal

Registration Form
E-mail the form back to 'info@sanog.org'. If you have filled this form, please do not use the online registration system. 

Please register me for SANOG IV in Kathmandu. 

Name			:  _______________________________________
Organization		:  _______________________________________
Membership 		: CAN / ISPAN / npIX / APIA / APNIC / RIPE (Please circle one)
Address		:  _______________________________________
e-mail		 	: _______________________________________

Select Registration

•	Passport Registration (includes workshops, tutorials and conference)	USD 175/Nrs. 12,000.00
•	Workshop Only	USD 125/Nrs.  8,000.00
•	Tutorial, APCAUCE and Conference Only	USD 75 /Nrs.  5,000.00
•	Conference Only	USD 30 /Nrs.  2,000.00
•	One Day Registration (During Tutorials)	USD 25 /Nrs.  1,500.00
•	Social Function Only	USD 15 /Nrs.  1,000.00

Choose Workshop
•	
•	IP Services Workshop
•	ISP Routing Workshop
•	DNS/DNSSec Workshop

The fees will cover Lunches, stationery and tea/coffee during the day. One day registration will not include invitations to the social events. 10% Discount is given to members of SANOG Partners (APIA, APNIC, RIPE) and supporting organizations (npIX, CAN, ISPAN).

Payment Method

•	Please charge USD ____________ to my  Visa / Mastercard / American Express / ____________ 
Number ______________________________  Expiry Date____________

•	I'll pay be bank transfer, please send me details.

•	I'll pay on-spot.

__________________________________
Signature

Date: