Registration Form

Please fill in (type or use block letters) and fax this credit card payment form to:

Sergio Arévalo
Fax: +34-91-6647490

___ Mr.    ___ Ms.  First name(s):...........................................

Family name   : .............................................................



___   Early registration  (before Aug 20, 2000)    300 Euros
  
___   Late registration   (after Aug 20, 2000)     375 Euros

___   Students  (before Aug 20, 2000)              150 Euros

___   Students  (after Aug 20, 2000)               200 Euros

                                                  ____________
                                             
                          Total amount:        ....... Euros



___  Please, charge my credit card   

     __ VISA             __ EUROCARD/MASTERCARD
 
   Card No.: ..................................   Exp. Date: ................
 
   Name on card: ............................................................
 
   Date:      ...................................
 
   Signature: ...................................

In case of problems with this form, please contact: s.arevalo@escet.urjc.es

root
2000-07-16