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