eunite 2002 - Registration Forms

eunite 2002 -
Registration and Information Form FAX: +49 2408 94582

If you want to register, please return this form to:
eunite Service Center, c/o ELITE Foundation, Pascalstr. 69, 52076 Aachen, Germany

I register for:

A: Symposium

	Early Registration until and including 15 July 2002	Late Registration after 15 July 2002
Participants	Industry Rate: Euro 200.- University Rate: Euro 150.-	Industry Rate: Euro 250.- University Rate: Euro 200.-
Members of EUNITE* and Speakers**	Industry Rate: Euro 150.- University Rate: Euro 100.-	Industry Rate: Euro 200.- University Rate: Euro 150.-
Undergraduate Students	Euro 100.-	Euro 100.-

* This is valid for all Nodes of the Network, who have submitted the necessary information by 30 April 2002.
**Speakers who have an accepted contribution can participate in the symposium at the condition of EUNITE-Members.

B: Social programme:

Welcome reception on 19 September 2002, free of charge person(s)

C: Accommodation in the Hotel Falesia:

Date of arrival:
Time of arrival:
Date of departure:

Single Room (€ 75.- per night)
Double Room (€ 90.- per night) shared with

Travel details (if available):

Inbound Flight Number:
Outbound Flight Number:

Method of payment (we will send you an official invoice on receipt of your registration)

If you want to pay by creditcard, please print this form
and sent it by fax at +49 2408 94582!

I pay the amount of EUR by
cheque
bank transfer
Mastercard/Eurocard
VISA
American Express

Cardholder's name:	_______________________________________________________

Credit Card Number:	_______________________________________________________

Card Expiration date:	_______________________________________________________

Cordholders Signature:	_______________________________________________________

Bank transfers must be made 'free of charge for the beneficiary' (net of bank charges and commission). All bank charges or commissions reducing the amount will have to be paid in cash when registering. If you pay by credit card, 3% charges will be added to the total amount. To avoid any confusion, participants are requested to indicate clearly their names and addresses on transfer orders and cheques.

Address

Indicates required field.

Title:
Sex:		male female
First Name:
Last Name:
Company:
Number of Employees:
Department:
Position:
Street:
P.O. Box:
Postal Code/City:
Country:
Phone No.:
Telefax No.:
Email: