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