D I S C  '9 8


R E G I S T R A T I O N     F O R M 


Please, return this form to DISC'98 Secretariat
Computer Technology Institute [C.T.I.]
3, Kolokotroni Street, 26.221 Patras, Greece
Fax: +30.61.222.086
Telephone : +30.61.225.073 / 273.496
E-mail:         gourdoup@cti.gr


First Name : .................................................... Surname ............................................

Affiliation :  .................................................................................................

Address : ......................................................................................................

Zip Code : .............................................. City ........................................................

Country : ......................................................................................................

Phone : .............................................   Fax.: ................................................

E-mail : ........................................................................................................

Accompanying Person (s)...............................................................................


Registration Fee (s)
                                                Before 31/07/98 After 31/07/98

Regular Fee                                     GRD 80.000              GRD 100.000

Student Fee [*]                                 GRD 60.000              GRD   80.000

Conference Dinner [For accompanying person(s)]          GRD 12.000      

Extra Proceedings                               GRD 20.000

[*] Please also send a student certification, signed by your advisor.

Payment

Payment must be effected in Greek Drachmas [GRD]. All bank fees must be covered by the remitter. Please check the desired way of payment.

___     Bank transfer to the account: C.T.I., General Hellenic Bank, Branch of Patras, Bank Account007-03-0320420  [Please include copy of Bank transfer order].

Please charge the following credit card:
 ___    VISA
Cardholder's Name _________________________________ Expiration Date ___________

Card Number ________________________________ Cardholder's Signature _________