WDAG'97
Registration Form
(also in
simple text, or
postscript form)
Please read the information brochure, then type/print clearly and send to:
(if you use fax, please *do not forget* to also send the original by mail)
WDAG'97 SECRETARIAT (Att. Roxane Wetzel)
Max Planck Institut fuer Informatik FAX: +49-681-9325-999
Im Stadtwald, D-66123 Saarbruecken, GERMANY.
First Name_______________ Last Name__________________________ [ ] Ms [ ] Mr
Affiliation________________________________________________________________
Address____________________________________________________________________
City______________________ Post-Code_____________ Country__________________
E-mail_________________________ URL________________________________________
Phone__________________________ Fax________________________________________
============================== FEES / PAYMENT / GRANTS ====================
Reg. Fee includes Proceedings, 3 Lunches, Conf. Dinner, Breaks, Soc. Program
Before August 22, 1997 After August 22, 1997
RegularFee / StudentFee(*) 435 DM / 335 DM 535 DM / 435 DM
(*) please also send a Student Certification, signed by your advisor
Amount Paying: _________ Way of Payment (please check one):
[ ] BankTransfer [ ] Euro/MasterCard [ ] VISA
If you pay by BankTransfer, please send us also a photocopy of the Transfer
Order; if you pay by Credit Card, please fill in the following:
Credit Card # ________________________ Expir. Date (month/year) __________
Name of Card-Owner________________________________________________________
I hereby authorize MPI-Informatik to debit my card for the amount above:
Signature of Card-Owner___________________________________________________
Apply for a grant? [ ] No [ ] Yes: please E-MAIL (wdag97@mpi-sb.mpg.de)
or FAX, by August 22, a brief CV (incl. your status, age and nationality)
and a brief letter by your scientific advisor or ALCOM-IT site coordinator.
============================= MEALS / ACCOMMODATION ==========================
Do you prefer vegetarian meals? [ ] Yes [ ] No
Would you like us to reserve accommodation for you? [ ] Yes [ ] No
(Please note that acommodation is *not* included in the registration
fee; you can pay directly at the hotel when you are here.)
# Nights____ Arr.: Sept.___'97 (Approx. time_____) Depart.: Sept.___'97
Hotel group that you prefer: [ ] Group I (Economy) [ ] Group II
Room: [ ] single [ ] 2-bedded/double, own use
[ ] 2-bedded, sharing with___________________________________________
[ ] 2-bedded; please find for me someone to share the room with
Date__________________________ Signature____________________________________