REGISTRATION FORM A

 

! REGISTRATION DEADLINE: FRIDAY SEPTEMBER 27 !

Please completely fill in the form below and click the 'Submit' button in the bottom-left corner of the form to send your registration online to the Conference Secretariat. If online registration has been completed succesfully, you should get a web page confirming this. If online registration has failed, you will get a web page stating this. Failing to register online may be due to not filling in required form fields. If you can not fill in a required form field (e.g. fax, in the case you do not have a fax), mark XXX in the text box and it should work out fine then. 

Family name:Initials:Male Female

Title/Profession:

Institution/Company:

Postal address:

                     

City/ZIP code:

Country:

Phone: Fax:

E-mail:


                                                                                                               Total

Registration fees        before July 15, 2002    220,00 (Euro)

                               after July 15, 2002      250,00 (Euro)            (Euro)

    !!! AFTER JULY 15, ONE CANNOT REGISTER AT THE RATE OF 220 (EURO) ANYMORE !!!

Conference activities    I will be participating in the    yes    no

                                   pre-conference workshop

                                   (49,00 Euro)                                                (Euro)

 

                                           I will be attending the          yes    no

                                   conference banquet

                                   with * accompanying person(s)

                                   (49,00 Euro per person)                                 (Euro)

                                   (* fill in how many - if any - persons will be accompanying

                                   you at the conference banquet, not counting other

                                   conference participants!)

 

                                           TOTAL PAYMENT IN EURO ():                          (Euro)

 

I will be attending the welcome reception    yes    no

(included in registration fee)

 


Method of payment

    Please record "P9723, SICDS - <name participant>" on all methods of payment

    Make international money orders and cheques payable to: UNIVERSITEIT GENT,

    SICDS CONFERENCE, Sint-Pietersnieuwstraat 25, Ghent, Belgium

Credit card

        Eurocard/Mastercard    VISA    American Express    Diners Club

         Card expiry date:

         Name official card holder:

International money order to 001-1950612-18 of FORTIS BANK, Warandeberg 3, Brussels, Belgium

    (make sure to give your financial institution the payment order around the same time as your

    registration)

Registered bank cheque (personal or company cheques cannot be accepted)

    (please enclose the cheque with a completed and signed registration form to be sent to the

    Conference Secretariat)

            ! DO NOT FORGET TO FILL IN REGISTRATION FORM B !