%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% % % % REGISTRATION FORM % % % % ICALP '97 % % % %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Please return this form to Italiana & Co. - ICALP'97 Via Altabella 3 I-40126 BOLOGNA (Italy) Fax: + 39 51 222881 Email: italiana@bo.nettuno.it If you are paying by bank transfer, you may return the registration form by e-mail or by fax. If you are paying by Eurocheque, you should return your registration form and cheque by physical mail. Name: _____________________________________________________ Affiliation: ______________________________________________ Address: __________________________________________________ ___________________________________________________________ Country: __________________________________________________ Phone: _______________________ Fax: _______________________ Email: ____________________________________________________ Date of Arrival:_____________Date of Departure:____________ For lunches, do you have any special dietary requirements? vegetarian [ ] Other dietary restrictions, please specify: ___________________________________________________________ I will attend the conference banquet (y/n) :_______________ I need extra banquet tickets (number) :____________________ Item Amount ICALP registration fee _________ ITL AIN-FMICS registration fee _________ ITL Post-Workshops registration fee _________ ITL Extra banquet tickets _________ ITL Other expenses (specify below) _________ ITL Bank charge (20,000 ITL) _________ ITL TOTAL _________ ITL Specification for other expenses:__________________________ ___________________________________________________________ - Check enclosed [ ] - Payment by Bank transfer [ ] - Payment by Credit card at the desk (late registration only) [ ] Eurocard/MasterCard [ ] VISA [ ] Name of card holder ____________________________________ Card number ____________________________________________ Expiration date ________________________________________ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% % % % HOTEL RESERVATION FORM % % % % ICALP '97 % % % %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Please return this form to Italiana & Co. - ICALP'97 Via Altabella 3 I-40126 BOLOGNA (Italy) Fax: + 39 51 222881 Email: italiana@bo.nettuno.it Name: _____________________________________________________ Affiliation: ______________________________________________ Type of room(single/double/triple):______ Number of nights: _______ I wish to share my room with:______________________________ Hotel choice (please number 1st choice 1, 2nd choice 2, ...): Holiday Hotel*** ______ University Hotel*** ______ Hotel Regina*** ______ Hotel Europa*** ______ Hotel Tre Vecchi**** ______ Hotel Orologio*** ______ Hotel Commercianti*** ______ Hotel Corona D'Oro**** ______ Collegio Erasmus ______ Arrival date ___________ time __________ Departure date ___________ time __________ In order to guarantee your accommodation, please indicate the references of your credit card: Eurocard/MasterCard [ ] VISA [ ] Others credit cards [ ] (specify)_______________________ Name of card holder ______________________________ Card number ______________________________________ Expiration date __________________________________ daytime telephone ________________________________ ************************************************************************