CONFERENCE REGISTRATION FORM
( Please fill in BLOCK CAPITALS and mark X where appropriate (instead of _)) DELEGATE Family name: ________________________ First name: _______________ _F _M Title: ______________________________ Position: ____________________________ Institution (as to appear on badge): _________________________________________ Institution (full name): _____________________________________________________ Address: _____________________________________________________________________ Postal code: __________ City: _____________ Country: __________________ Phone: ______________________________ Fax: _______________________ Email: _____________________________________________________________ ACCOMPANYING PERSON Family name: ________________________ First name: __________________________ PRESENTATION I would like to present the paper Author(s): _________________________________________________________ Title: _____________________________________________________________ _____________________________________________________________ _Please send me the formatting details by _email _mail _I am going to attend TUTORIALS: _1 _2 _3 _4 (no additional charge for tutorials) HOTEL RESERVATION (CONTINENTAL HOTEL) Arrival date: ___________ Arrival time: ___________ Departure date: ___________ Number of nights: ___________ Room required: __ single room ( 92 DM ) __ double room ( 120 DM ) __ double room to be shared with __________________________ (60 DM/person) Prices indicated are per room, per night and include buffet breakfast and VAT. In order to confirm my hotel reservation I am transfering one night's accommodation : ________ DM to the Sup'Eur96 account. The rest of the hotel payments will be made directly at the Continental Hotel (by cash, or credit card: American Express, Diners Club, Eurocard, MasterCard, Visa) on arrival. In case of cancellation of hotel reservation after June 29, 1996, the Hotel may charge the first night. FEE and DEPOSIT Advance registration* (sent by June 29, 1996) (350 DM) __________ DM Late registration (sent after June 29, 1996) (450 DM) __________ DM Additional guest for the conference dinner (100 DM/person) __________ DM Discount for author (one per each accepted paper) (-150 DM) __________ DM Hotel deposit (92 / 120 / 60 DM) __________ DM TOTAL PAYMENT __________ DM PAYMENT I am transfering TOTAL = _______ DM to bank account: Sup'Eur 96 No: 535078-7024641-3111-1110 Bank PeKaO S.A. o/Krakow Rynek Gl. 31 31-042 Krakow, POLAND Date: ________________________ Signature: _____________________________ * 80% refund if cancelled by June 29, 1996. No refunds afterwards.
Please return this form to: Prof. Jacek Moscinski - SUP'EUR 96 ACC CYFRONET-KRAKOW P.O.Box 386 ul. Nawojki 11 30-950 Krakow 61, Poland We would be very grateful if you sent also the copy of this form by: - email to: supeur96@cyf-kr.edu.pl or - fax: (+48 12) 341 084; 338 054