Please complete and sign this form. Use one form per person and write
in capital letters.
Send it by postal mail or fax to:
Carlos Delgado Kloos. General Chair Universidad Carlos III de Madrid. C/ Butarque 15, E-28911 Leganés (Madrid) Spain Fax: (+34-1) 624-9430. E-mail: chdl97@it.uc3m.es |
I will attend the Toledo'97 events.
Last name: | ...................................................................................................................................... | ||||
First name: | ...................................................................................................................................... | ||||
Affiliation: | ...................................................................................................................................... | ||||
Address: | ...................................................................................................................................... | ||||
Postal code: | .................... | City: | ..................................... | Country: | ........................................... |
Phone: | .................... | Fax: | ..................................... | E-mail: | ........................................... |
Registration fees (in Pesetas) |
On/before March 8 |
After March 8 |
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TOTAL FEE (in Pesetas) ..................................... |
Methods of payment (all payments in Spanish Pesetas):
eurocheque (must accompany registration form) in Pesetas, payable to Universidad Carlos III de Madrid. | |||||||||
cheque (must accompany registration form) in Pesetas, drawn to a Spanish bank, payable to Universidad Carlos III de Madrid (fees to be charged to the issuer of the cheque). | |||||||||
bank transfer to: Univ. Carlos III de Madrid, Ref. 442. Account: 2110064856; Bank code: 0049-0581-19. Bank Name: Banco Central Hispano. Address: Juan de la Cierva 38, E-28911 Getafe/Madrid Fees to be charged to the participant. Please indicate participant's name and affiliation in the transfer! |
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credit card: Mastercard/Eurocard Visa
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Cancellation by postal mail or fax is possible if received by April 1, 1997; 75% of the payment will be refunded. After that date, no refunds will be made. A substitute participant can be named at any time.
Please specify your dietary requirements for lunch and conference banquet and any other requirements.
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Date | Signature |