IS&N’99
&
AGENT WORKSHOP

REGISTRATION FORM

Return (only by fax) registration form to:
Mrs. Mercè Calvet
Dept. Arquitectura de Computadors
Universitat Politècnica de Catalunya (UPC)
Jordi Girona, 1-3, Mòdul D6
E-08034 Barcelona, SPAIN
Fax: (+34) 93 401 70 55

Please print or type:

Full Name ______________________________________________________________

Company/ Affiliation: _____________________________________________________

Mailing Address: _________________________________________________________

________________________________________________________________________

City/Country: ____________________________________________________________

Phone: _____________________________    Fax: _______________________________

E-mail: ____________________________ (We will confirm you the registration by e-mail)

CONFERENCE (27th -29th April, Telefónica, Barcelona) registration fees (please put a tick against the appropriate box):
				Advance		Late
				(Until 15th April, 1999)	(After 15th April, 1999)
Regular				 450 EUROs		 540 EUROs		
University member		 350 EUROs		 420 EUROs
First day entrance (27th April)	 150 EUROs		 180 EUROs	
Extra banquet ticket (27th April)	 60 EUROs		 60 EUROs

The full conference fee includes admission to the technical sessions and showcase, proceedings book, reception, refreshment breaks, lunches and gala dinner.
The first day fee does not include the gala dinner.
The conference registration fee for IS&N’99 speakers has a discount of 10%.
IS&N’99 speaker  	 Yes 	 No

Conference registration amount due: 	EUROs ________(A)

WORKSHOP (26th April, UPC, Barcelona) registration fees (please put a tick against the appropriate box):
				Advance		Late
				(Until 15th April, 1999)	(After 15th April, 1999)
Regular				 100 EUROs		 120 EUROs		

Workshop registration amount due: 	EUROs ________(B)

TOTAL AMOUNT DUE:				EUROs ________(A+B)

METHOD OF PAYMENT:
 Bank Cheque in EUROs payable to UPC-ISN99 (please fax  a copy of the cheque and send us the original by postal mail to the address indicated above)

Credit Card:	 VISA		 MasterCard	 American Express

Credit card number: ________________________________________   Expiration date: ____/ ____

Cardholder Name: __________________________________________

Signature: __________________________