PATMOS '98 - Registration form

First name:  
Family name:  
Prof./Dr./Mr./Ms.:  
Company/University:  
Address:  
Address:  
Address:  
Telephone:  
Fax:  
Email:  
Diet (Standard, Vegetarian, Diabetic):  

WORKSHOP
  Early registration (Before Setember, 11) DKK 2,700  
  Late registration (After September, 11) DKK 3,000:  
TUTORIAL
  Low Power Design DKK 300:  
Accompanying person (Evening):
  Wednesday Oct. 7, (Buffet and Experimentation) DKK 600:  
  Thursday Oct. 8, (Dinner) DKK 400:  
Total amount in DKK:  

Method of payment (check one)
 |__|  I enclose a bank checque issued in DKK to:

 PATMOS '98
 Dept. of Information Technology
 DTU. Building 344
 DK-2800 Lyngby
 DENMARK
 
 
 
 
 
 

 |__|  Please change my Credit Card:
 __________________________________________________
 Name of card:
 __________________________________________________
 Card number:
 __________________________________________________
 Expiration date:
 __________________________________________________
 Name of cardholder:
 __________________________________________________
 Amount due:
 __________________________________________________
 Signature:

CANCELLATION: Before September 11 = 80%, After September 11 = 10%.

Return this form to:
PATMOS '98
Attn.: Ms. Maria Hansen
Department of Information Technology
Building 344
Technical University of Denmark
DK-2800 Lyngby
DENMARK
Email:
Fax:
Phone:
 
 
patmos@it.dtu.dk
+45 4593 0074
+45 4525 3744