Physics Computing ' 96
CONFERENCE REGISTRATION FORM
( Please fill in BLOCK CAPITALS and mark X where appropriate (instead of _))
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DELEGATE
Family name: ________________________ First name: _______________ _F _M
Title: ______________________________ Position: ____________________________
Institution (as to appear on badge): _________________________________________
Institution (full name): _____________________________________________________
Address: _____________________________________________________________________
Postal code: __________ City: _____________ Country: __________________
Phone: ______________________________ Fax: _______________________
Email: _____________________________________________________________
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ACCOMPANYING PERSON
Family name: ________________________ First name: __________________________
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PRESENTATION
I would like to present the paper _oral _poster
Author(s): _________________________________________________________
Title: _____________________________________________________________
_____________________________________________________________
_Please send me the formatting details by _email _mail
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_I am going to attend TUTORIALS: _1 _2 _3 _4 _5 _6
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HOTEL RESERVATION (the CONTINENTAL HOTEL)
Arrival date: ___________ Arrival time: ___________
Departure date: ___________ Number of nights: ___________
Room required:
__ single room ( 73 Sfr )
__ double room ( 93 Sfr )
__ double room to be shared with __________________________ (47 Sfr/person)
Prices indicated are per room, per night and include buffet breakfast.
In order to take advantage of the preferential rates at the Continental
Hotel one should transfer total payment for the room together with the
fee to the Computational Physics Group EPS bank account.
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FEE and HOTEL PAYMENT
Advance registration* (sent by June 15, 1996) (180/240/140 Sfr)________Sfr
Late registration (sent after June 15, 1996) (240/290/200 Sfr)________Sfr
Additional guest for the conference dinner (80 Sfr/person)________Sfr
Tutorials (30/50/70 Sfr)________Sfr
Hotel payment (No of nights * 73/93/47 Sfr per night) ___________Sfr
TOTAL PAYMENT __________Sfr
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PAYMENT
I am transfering TOTAL = _______ Sfr to bank account:
Name: Computational Physics Group
European Physical Society
Number: 01-65550000/0300
Bank: Ceskoslovenska obchodni banka, a.s.
115 20 Praha 1
Na prikope 14
Czech Republic
Date: ________________________ Signature: _____________________________
* 80% refund if cancelled by June 15, 1996. No refunds afterwards.
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Please return this form to:
Marian Bubak - PC'96
ACC CYFRONET-KRAKOW
P.O.Box 386
ul. Nawojki 11
30-950 Krakow 61, Poland
We would be very grateful if you sent also the copy of this form by:
- email to: pc96@cyf-kr.edu.pl
or
- fax: (+48 12) 341 084; 338 054
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THANK YOU VERY MUCH FOR YOUR COOPERATION
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