| Please fill out this form and fax or mail it to: | Prof. Manfred Gilli | |
| University of Geneva | ||
| 102 Bvd Carl-Vogt | ||
| CH-1211 Geneva, Switzerland | ||
| Fax: +41 22 705 8299 |
| 240 SFr | Regular registration* (on or before May 20) | ___________ | |
| 350 SFr | Late registration* (after May 20) | ___________ | |
| 50 SFr | Students | ___________ | |
| 600 SFr | Non academic* | ___________ | |
| 100 SFr | Conference banquet** | ___________ | |
| 12 SFr | SCE membership for 1996 (~10 US$) | ___________ | |
| Total SFr | ___________ |
| Name: | _______________________________________________________ |
|---|---|
| Affiliation (for badge): | _______________________________________________________ |
| Address: | _______________________________________________________ |
| email (important!): | _______________________________________________________ |
| phone (important!): | _______________________________________________________ |
| fax: | _______________________________________________________ |
Check one of the following items:
I authorize a credit card payment of __________ SFr, total, as payment for my conference fees.
__ Visa __ MasterCard Account Number:___________________________________________ Exp. date ___-___
Date:__________ Signature:____________________
You may pay by bank money order in Swiss Francs or an international money order to:
| Union de Banques Suisses | |
|---|---|
| Account: | 472.319.00 D (UGE Comptabilite UNI2) |
| Pay to: | CEF96 160.636 |
| Swift: | UBSWCHZH12A |
Checks cannot be accepted. Please do not send cash of any kind.
A postscript version of this document can be downloaded here.
An Adobe Acrobat version of this document can be downloaded here.