1999 EUSFLAT - ESTYLF JOINT CONFERENCE. FORM REGISTRATION

1999 EUSFLAT - ESTYLF JOINT CONFERENCE

Registration Form

Surname	Institution/Company
First Name	Address
Phone	ZIP/Postal Code
Fax	City
E-mail	Country

	Before July 10th	After July 10th	Amount
Eusflat members	30.000 Pts	40.000 Pts
Non members	37.000 Pts	47.000 Pts
Students	15.000 Pts	15.000 Pts
Accompanying persons	10.000 Pts	10.000 Pts

TOTAL AMOUNT DUE: ............................................. Pts

PAYMENT BY CREDIT CARD

VISA

MASTERCARD

Name on card: _______________________ Number: ______________________

Expiration date: ______________ Signature: _____________________

PAYMENT BY BANK TRANSFER TO

	Eusflat Congress
Account No: Name of the Savings Bank: Address:	2051 0091 17 0361212622 "Sa Nostra" Caixa de Balears Ctra. de Esporles, 25
	07010 Palma de Mallorca.
	Spain

A copy of the receipt of the bank remittance should be attached to the Registration Form

Send a copy by mail or fax of the Registration Form to the Conference Secretariat:

Prof. T. Calvo (EUSFLAT99)
Dept. of Mathematics and Computer Science
Universitat de les Illes Balears
Ctra. de Valldemossa, km. 7.5
07071 Palma de Mallorca. Spain
fax: +34 971 173003

An acknowledgement of receipt will be sent to each registrant after his/her Registration Form and fee are received.

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