IFIP Working Group 8.2 Working Conference |
August 20 - 21, 1999 |
Registration Form |
| Please print or type and return the form
together with your payment to: IFIP Working Group 8.2 c/o Dr. Marius Janson University of Missouri - St. Louis 8001 Natural Bridge Road St. Louis MO 63121 USA Ph: (314)516-5846 - Fax: (314) 516-6827 |
| Participant (Mr. , Ms. ) | |
| Family Name: | ____________________________________________ |
| First Name: | ____________________________________________ |
| Title/Profession: | ____________________________________________ |
| Institution: | ____________________________________________ |
| Address: | ____________________________________________ |
| Postal code: | ____________________________________________ |
| City: | ____________________________________________ |
| Country: | ____________________________________________ |
| Telephone: | ____________________________________________ |
| Fax: | ____________________________________________ |
| E-mail: | ____________________________________________ |
| No. of Persons |
Registration Fees (in US
Dollars) Only one participant per form |
Before 06/30/99 USD |
After 06/30/99 USD |
On-site USD |
USD |
1 |
Participant | $375.00 | $400.00 | $425.00 | |
1 |
Student (subject to eligibility, see below for eligibility) | $175.00 | $200.00 | $225.00 | |
| Social Events - Please tick | |||||
| Get-together Party, Aug 19 Yes No |
Inclusive |
||||
| Conference Dinner, Aug 20 Yes No |
Inclusive |
||||
| Total | |||||
| All payments must be made in US Dollars (USD) and payable to IFIP WG 8.2, c/o Marius Janson. |
| Registration will be confirmed only when the payment is received. Payment must be remitted by banker's draft or check drawn on a US Bank. |
Note: The organizing chair is presently trying to make arrangements for payment by credit card. Decision will be available shortly. |
| I herewith confirm the registration by my signature below. |
| Date:___________________________ |
Signature: ___________________________ |
| Remember to make a copy of this form for your own files |
Student Eligibility |
| I hereby certify that the above mentioned student is enrolled as a full-time student at this University |
Head of the Department (please print): _______________________________________________ |
| Affiliation: ________________________________________________________________________ |
| Address: _________________________________________________________________________ |
| Telephone: ____________________ Fax: ___________________ E-mail: ____________________ |