SOFSEM '97 - Registration Form

SOFSEM'97 - Registration Form

Please
mail,
e-mail
or fax to:

Z. Walletzka, SOFSEM '97
UVT MU,
Botanicka 68, 602 00 Brno
Czech Republic

Fax
e-mail::

+420-5-4121 2747
sofsem@ics.muni.cz

          SOFSEM'97 REGISTRATION FORM AND PAYMENT NOTICE

Z. Walletzka, SOFSEM '97
UVT MU
Botanicka 68, 602 00 Brno
Czech Republic
fax: +420-5-4121 2747          e-mail: sofsem@ics.muni.cz

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

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

        Organization:           ........................

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

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

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

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

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

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

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

        Vegetarian Meals:       YES     NO
        Type of Fee:            S0      S1     S2     S3
        Member of CSCS/SSCS     YES     NO

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

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

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

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

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

SOFSEM'97 - Registration Form

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