SOFSEM'96 - Registration Form

Please e-mail or fax to:

Z. Walletzka --- SOFSEM '96

UVT MU

Botanicka 68, 602 00 Brno

Czech Republic

fax: +42-5-4121 2747

e-mail: sofsem@ics.muni.cz

                REGISTRATION FORM AND PAYMENT NOTICE

Z. Walletzka --- SOFSEM '96
UVT MU
Botanicka 68, 602 00 Brno
Czech Republic
fax: +42-5-4121 2747
e-mail: sofsem@ics.muni.cz


        Family name (Mr, Ms) :  ........................

        First name:             ........................

        Affiliation:            ........................

        Current position:       ........................

        Address:                ........................

        Phone:                  ........................

        E-mail:                 ........................

        Amount of Payment:      ........................

        Date of Payment:        ........................

        Details of Payment:     ........................

        Single or Double Room:  ........................

        Vegetarian Meals:       YES     NO

        Type of Fee:            S0      S1     S2     S3

        ACM member number:      ........................

        Member of CIS/SIS       YES     NO

        Passport:               ........................
        (CZ/SK participants
          "rodne cislo / COP"   ........................)

        Comments:               ........................

                                ........................

        Date:                   ........................