eunite 2004
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

Please keep me informed about eunite 2004

I will submit a paper entitled:

I propose to organise the following session:

I register for the Symposium

 

Early Registration until and including 15 April 2004

Late Registration after
15 April 2004

Participants

Industry Rate: Euro 250.-
University Rate: Euro 200.-

Industry Rate: Euro 300.-
University Rate: Euro 250.-

Members of EUNITE* and Speakers**

Industry Rate: Euro 200.-
University Rate: Euro 150.-

Industry Rate: Euro 250.-
University Rate: Euro 200.-

Undergraduate Students

Euro 100.-

Euro 100.-

* This is valid for all Nodes of the Network, who have submitted the necessary information by 29th of February 2004.
**Speakers who have an accepted contribution can participate in the symposium at the condition of EUNITE-Members.


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

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Title:

 

Sex:

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 male       female

First Name:

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Last Name:

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Company:

 

Number of Employees:

 

Department:

 

Position:

 

Street:

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P.O. Box:

 

Postal Code/City:

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Country:

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Phone No.:

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Telefax No.:

 

Email:

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