This form is to register for the WG'98 conference. Send it, please, as soon as possible (at the latest 18 May) by email (without signature) to: email@example.com or by fax to +421-7-375859.
PERSONAL INFORMATION ==================== PARTICIPANT: Surname (Mr.,Ms.):______________________ First Name:__________________________ Title (Prof.,Dr.):______________________ Position:____________________________ Affiliation:__________________________________________________________________ Address: __________________________________________________________________ ZIP code: _____________ City:___________________ Country:___________________ Phone: _____________ Fax: ____________________E-mail: ___________________ ACCOMPANYING PERSON(S): Surname (Mr.,Ms.):________________________ First name:________________________ Surname (Mr.,Ms.):________________________ First name:________________________ _______________________________________________________________________________ HOUSING ======= Room type (if available) - show the preferences by numbers from 1 to 3: (The prices are for the whole conference - 3 nights. It is impossible make a reservation for only 1 or 2 nights.) Apartment/Single (630 DM) [ ] *Apartment/Double (315 DM) [ ] Single (270 DM) [ ] Double/Single (450 DM) [ ] *Double/Double (225 DM) [ ] Double/Single (360 DM) [ ] *Double/Double (180 DM) [ ] shared bathroom and WC shared bathroom and WC *Triple/Double (270 DM) [ ] *Triple/Double (225 DM) [ ] shared bathroom and WC If you choose a case marked by * and do not have a companion, please, provide the name of your possible room-mate: Surname (Mr.,Ms.):________________________ First name:________________________ IMPORTANT NOTICE: ***************** As the capacity is limited, please, make your reservation as soon as possible! Your housing reservation will be decided upon and confirmed after receiving all registration forms by 20 May 1998. _______________________________________________________________________________ BOARD ===== Preference for vegetarian menu (default is NO): participant YES [ ] NO [ ] accompanying person(s) YES [ ] NO [ ] _______________________________________________________________________________ CONFERENCE FEE ============== participant 180 DM (Deutsche Mark) accompanying person 130 DM (Deutsche Mark) The conference fee includes proceedings, meals, social events, and transportation by the conference bus. _______________________________________________________________________________ LATE FEE (added to the total amount if paid after 31 May 1998) ======== participant 100 DM accompanying person 100 DM _______________________________________________________________________________ PAYMENT ======= Payment details will be communicated to you with the confirmation of your housing reservation by 20 May 1998. Deadline for payments is 31 May 1998. Signature______________________________________