33YoGB Registration Form
Name:................................................................
Affiliation:.........................................................
Full address:........................................................
.....................................................................
Country:.............................................................
e-mail:..............................................................
Telephone:...........................................................
Telefax:.............................................................
For lunches etc.: o vegetarian o regular food
Conference fee:
Fees are given in Austrian schillings. Exchange rate on Nov. 9:
1 USD = 12 ATS.
o registration for tutorial lectures only ATS 1800
o registration for research presentations only ATS 3200
o registration for full conference program ATS 4000
o student registration for tutorial lectures only ATS 900
o student registr. for research presentations only ATS 1600
o student registration for full conference program ATS 2000
o number of banquet tickets, price per ticket ATS 500
Total costs: ATS ...............
Payment:
Payment should be made in Austrian schillings. Please note that bank
fees must be paid by the participant.
o payment will be made by bank transfer into the following account:
Raiffeisenbank Hagenberg-Pregarten
BLZ (bank code): 34151
Account number: 620 000 25320
Specify: "33 YoGB" and name of participant
o I add a bank cheque for the above total fee payable to the account
"33 YoGB"
Raiffeisenbank Hagenberg-Pregarten
BLZ (bank code): 34151
Account number: 620 000 25320
o I hereby authorize the conference treasurer to charge my credit
card for the amount mentioned in "Total costs".
o American Express
o Eurocard/Mastercard
o Visa
Card holder's name: .................................................
Credit card number:......................... Expiration date:........
Special requests:....................................................
.....................................................................
.....................................................................
.....................................................................
Date:........................... Signature:.........................
The completed form can be either mailed, faxed or emailed to:
Mrs. Betina Curtis
RISC-Linz
Johannes Kepler Universitaet Linz
A-4040 Linz, Austria
tel: +43 732 2468 9921
fax: +43 732 2468 9930
email: bcurtis@risc.uni-linz.ac.at