~ ParCo99 | Registration form
ParCo99
Registration Form

Each participant should use a separate registration form or a copy thereof.


Return completed forms to the Conference Office

Name** :
Title :First name/
Initials :
Organisation :Department :
Address** :
Postal Code** :City** :
ZIP Code :Country** :
Tel. :Fax :
e-mail :
** means 'required'. You have to fill out these fields.


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Registration Payment (Before 1.7.1999) Late Payment (From 1.7.1997)
Full Registration Euro.515,= Euro.670,=
Basic Registration Euro.400,= Euro.550,=
Companion (social events) Euro.55,= Euro.55,=


Total Amount Due =    Euro


NOTE: All amounts are in Euro

Please make cheque and bank transfer payments free of charge
Amount due paid by:


Enclosed cheque


Bank transfer
     Bank Transfer to:
     Account no. 40 82 55 226
~
ParCo Conferences
ABN-AMRO Bank
Firmamentlaan 1
5632 AA
Eindhoven
The Netherlands


Credit Card Visa
Mastercard
Card number:    
Expiration date:   (dd-mm-yyyy)
If you use Matercard, the address at which the card is registered, is also required:
Street   Nr.
City
PostalCode
Country






Signature:________________________________          Date: 1-03-2000 (dd-mm-yyyy)

    


Conference office
ParCo99
Faculty of Information Technology and Systems
Department of Computer Science
P.O.Box 356
2600 AJ Delft The Netherlands

Tel:+31-15-2788700
Fax:+31-15-2787141
e-mail:parco99@tudelft.nl
WWW:http://www.parco99.tudelft.nl

ParCo99