MCM2001 REGISTRATION FORM

Please print and send by Fax to

MCM2001
Department of Mathematics
University of Salzburg
Hellbrunner Str. 34
A-5020 Salzburg
AUSTRIA
FAX: (0662) 6389-5309 (within Austria), otherwise +43-662-6389-5309



Please print or type.

Name: __________________________________________  
  
Title: _________________________________________  
  
Organization: __________________________________  

Department: ____________________________________

Street Address: ________________________________   

City: ____________________________  Zip: _______  

Country: _______________________________________  

Phone: (___) ___________ E-mail: _______________


I am (co-)author of the following accepted paper for MCM2001: 

______________________________________________________________


I will be accompanied by ________ (non scientific) persons.


Arrival date (if known)   __________________.

Departure date (if known) __________________.





CONFERENCE FEE (please indicate type of payment)

The regular fee includes welcome reception, coffee breaks, lunches, 
conference material, ..., and a conference dinner in Klessheim Palace, 
a beautiful Baroque palace near Salzburg.

[ ] CREDIT CARD

      +-----------------------------------------------------------------+
      |                          Conference Fee                         |
      +-------------------------------+---------------------------------+
      |          IMACS-member         |         non-IMACS Member        |
      +-----------------------------------------------------------------+
      | before July 27 |     LATER    |  before July 27  |     LATER    |
      |    EURO 250    |    EURO 285  |     EURO 265     |   EURO 300   |
      +-----------------------------------------------------------------+	    
      

I transfer an amount of EURO _____________  to MCM2001 Registration.

Credit Card type:	__ Master Card
			__ Visa

	Cardnumber: _____ ______ ______ ______   Expiry Date: ___/___

	Cardholder: ____________________


        Authorizing Signature: _____________________________ 


[ ] BANK TRANSFER

      +-----------------------------------------------------------------+
      |                          Conference Fee                         |
      +-------------------------------+---------------------------------+
      |          IMACS-member         |         non-IMACS Member        |
      +-----------------------------------------------------------------+
      | before July 27 |     LATER    |  before July 27  |     LATER    |
      |    EURO 280    |    EURO 315  |     EURO 295     |   EURO 330   |
      +-----------------------------------------------------------------+	    
      


        Account "MCM2001"  No. 01500152215
        Salzburger Sparkasse Bank AG
        A-5020 Salzburg, AUSTRIA   
        Bank code: 20404
        SWIFT code: SBGSAT2S


IMPORTANT NOTICE:

      in case of Bank-Transfer please fax the Registration-Form 
      AND an additional copy of a certified Bank-Transfer form!