Registration form -- FPSAC '97

PLEASE MAIL OR FAX THIS FORM TO:

Christian Krattenthaler, FPSAC'97
Institut für Mathematik, Universität Wien
Strudlhofgasse 4
A-1090 Vienna, AUSTRIA
FAX: +43/1/31367-4040 or +43/1/310 63 47

Full name : ____________________________________________________________

Affiliation and address : ____________________________________________________

____________________________________________________________________

Telephone : ______________________________ e-mail : ______________________________

I will attend the conference from _____________________ to ______________________________

I wish to make a reservation for a double - single room from ______________________________ to ______________________________

at Hotel Kaiser Franz Joseph : single (660 ATS) - double (880 ATS)
at Studentenheim Strudlhofgasse : single (210 ATS) - double (330 ATS)

N.B. The costs for the Studentenheim have to be payed in advance. Otherwise we cannot make a reservation.

I will ( ) / will not ( ) attend the "Heurigenabend" (conference dinner) on Thursday, July 17. I will be accompanied by ___ persons.

Payment : Payment (registration + hotel) must be made in Austrian currency

By bank transfer to Account Institut für Mathematik "FPSAC'97", Bank Austria, Bankleitzahl 20151, Konto Nr. 601 746 407.
By money order to FPSAC'97, Institut für Mathematik, Strudlhofgasse 4, A-1090 Vienna, Austria, or to Institut für Mathematik "FPSAC'97", Bank Austria (Schottenring 1, A-1010 Vienna, Austria), Bankleitzahl 20151, Konto Nr. 601 746 407.
By credit card : Mastercard - Visa - Eurocard
Card number : ______________________________
Expiration date : ______________________________

Registration fee : 2000 ATS (if received by April 30, 1997) - 3000 ATS (after April 30, 1997); Students : 1000 ATS (if received by April 30, 1997) - 1500 ATS (after April 30, 1997).

Studentenheim : ______________________________

Total : ______________________________ Signature: ______________________________