6th IEEE International On-Line Testing Workshop
Workshop Registration Form
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IEEE/CS Member |
Student Member |
Non Member |
| ADVANCE REGISTrATION (before June 7th) |
395 EURO |
290 EURO |
470 EURO |
| LATE/ON-SITE REGISTrATION (after June 7th) |
470 EURO |
340 EURO |
565 EURO |
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Registration includes coffee breaks, 3 lunches, welcome cocktail and social event. On-site registration is paid cash in Pesetas. |
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| Last Name: |
_________________________________________________________________
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| First Name: |
_________________________________________________________________
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| Organisation: |
_________________________________________________________________
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| Address: |
_________________________________________________________________
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_________________________________________________________________
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| Tel. Nr.: |
___________________________
| Fax Nr.: |
___________________________
| | E-mail: |
_________________________________________________________________ |
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| Nr. of Additional Social Event tickets (13.000 Ptas each): |
_________________ |
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Payment by credit card: |
 VISA or MASTERCARD |
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Card No: |
_________________________ |
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Card Expiration Date: |
_________________________ |
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Cardholder Signature: |
_________________________ |
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To be returned by June 7th to:
Marga Barrera
Avda. 16 de Julio, 73
07009 Palma de Mallorca, Spain
Tel. Nr.: +34 971 766 460
Fax Nr.: +34 971 766 570
E-mail: Mbarrera@uex.es
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If payment by bank transfer is preferred, send money to:
Ref. "IEEE" Ultramar Express BANCO DE SANTANDER, 0085.0749.43 Account Number 000.00.62.723, Gran Via Asima 2, Palma de Mallorca, SWIFT CODE BDERESMM. |
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Copyright © 2000 Laboratoire TIMA.
Tous droits réservés.