PATMOS '95 - Registration Form

Please return to:

PATMOS'95 secretary Andrea Heinen,
OFFIS
Escherweg 2
D-26121 Oldenburg, Germany
Fax:    +49 (0) 4 41/97 22-1 02


Name: ................................................... First Name: ................................................... Affiliation: ................................................... Address: ................................................... City: ................................................... Postalcode/ZIP: ................................................... Country: ................................................... Phone: ................................................... Fax: ................................................... E-mail: ................................................... Companion banquet tickets: ......................................... Payment: DM 550,- DM 600,- DM ........... is included by check: (yes) has been bank transfered: (yes) (please attach copy of remittance slip) Please order the airport shuttle Luftibus for me: arrival: ................................................... date time flight-no. departure: ................................................... date time flight-no. Date/Signature: ...................................................

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