CONFERENCE REGISTRATION FORM
12th European Conference on Object-Oriented Programming
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CONFERENCE REGISTRATION FORM |
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12th European Conference on Object-Oriented Programming |
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Please return this form by fax or regular mail to:
Orga-Med Congress Office, Mrs Ria Maes, Essenestraat 77, B-1740 Ternat, Belgium
Tel. +32 2 582 08 52 – Fax +32 2 582 55 15 – email: orgamed@club.innet.be
IDENTIFICATION PART
Last name: First name: Sex:
o M o FCompany / Affiliation:
Dept.:
Street/nr:
Postal code/City: Country:
Tel.: + Fax: + E-mail:
Accompanying person(s) (Last name and First name):
The above identification details will be used for future mailing lists which we may disclose to ECOOP and other conference organizers. Please tick the the box if you do not wish your name and address to be included:
oCONFERENCE REGISTRATION
Reduced fee section
Please indicate in order to qualify for reduced fee:
o
Student (this registration must be accompanied by an official letter)o
Eastern Europeano
ACM member number: .............o
AITO member number: .............This registration is submitted
o
By June 19 o By July 10 o After July 10Registration section
Please read the 'fee structure' section and complete with the corresponding amounts:
o
I want to register for the Tutorials ............ BEF
Circle your choices here (T = Tutorial):
T1 T2 T3 T4 T5 T6 T7 T8
T9 T10 T11 T12 T13 T14 T15 T16
Circle here the number of tutorial units chosen (1 unit = 1/2 day):
1 2 3 4
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I want to register for the ECOOP'98 ............ BEFo
I want to register for the Workshops-only ............ BEFo
I want to register for SCM-8-only ............ BEFo
I want a combined registration SCM-8 and ECOOP '98 ............ BEFo
I want to register the above mentioned accompanying person(s) ............ BEF
Please repeat last name :
Social Programme
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Exhibits Reception (20.07) x ...... pers. INCLUDEDo
Belgian Beer Degustation (21.07) x ...... pers. INCLUDEDo
Welcome Reception (22.07) x ...... pers. INCLUDEDo
Conference Banquet (23.07) x ...... pers. INCLUDEDo
Farewell Drink (24.07) x ...... pers. INCLUDEDDietary requirements:
Pre- and Post-Conference Trips
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Brussels (19.07) x ...... pers. ............ BEFo
Bruges (25.07) x ...... pers. ............ BEFPartner's Programme
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Package 1 (20-21.07) x ...... pers. ............ BEFo
Package 2 (22-24.07) x ...... pers. ............ BEFWorkshop Reader
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I want to order the following number of copies x ...... ............ BEFStudent Accommodation
(not to be filled in when staying in a hotel)
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I want to book a room for x ...... nights ............ BEFArrival date: ..../7/98
Departure date: ..../7/98
Type of room (please tick your choice)
o single (660 BEF/room/night)
o double (550 BEF/bed/night)
o 3-4 pers. room (450 BEF/bed/night)
o I don't mind sharing a 2 persons room
o I don't mind sharing a 3 / 4 persons room
o I will share my room with: ..............................................
o
I want to rent sheets (add 125 BEF) ............ BEFYouth hostel "Jacques Brel"
Zavelput 30 Rue de la Sablonnière, 1000 Brussels ____________
Total due: ............ BEF
METHOD OF PAYMENT
All payments should be made in Belgian Francs (BEF). Remittance should be free of any bank charges to the organisers. Please read the instructions for payment in the 'payment method' section.
Please indicate your method of payment:
o
Bank to bank transfer o Banker's draft o Eurochequeo
Credit card (please complete authorization section):o Eurocard/Mastercard o VISA o AMEX o Diners
Number ........................................................................... Exp. date ...../........
Name on card: ..................................................................
Signature of card holder: Date ..../..../.....