Please save this document to a file, fill in the information and send it to aca98@siduri.fjfi.cvut.cz even if you are sending your registration by fax or as hard copy (this is necessary for hotel Krystal reservation). Fax or hard copy registration should be send to Cotopaxi in the USA who will handle the conference finances. 4-th IMACS Conference on APPLICATIONS OF COMPUTER ALGEBRA (ACA'98) Prague, Czech Republic, August 9-11, 1998 REGISTRATION FORM PAYMENT MUST ACCOMPANY FORM AND MUST BE POSTMARKED BY June 30, 1998 FOR EARLY REGISTRATION FEE TO APPLY AND FOR HOTEL KRYSTAL RESERVATION CANCELLATIONS must be received in writing by JUNE 30 for REFUND (less $20 handling fee) ____________________________________, ___________________________________ Last Name First Name _________________________________________________________________________ Institution Full Unabbreviated Name _________________________________________________________________________ Mailing Address _________________________________________________________________________ City, State/Province, Zip/Postal Code _________________________________________________________________________ Country _________________________________________________________________________ Telephone Telefax E-Mail CONFERENCE REGISTRATION: (Check one) early standard on-site ____ IMACS member $110 $130 $150 ____ IMACS non-member $130 $150 $170 ____ student $80 $100 $120 ____ to be paid by IMACS-ACA (I have obtained approval of support) (Check one) ____ early registration - postmarked on or before June 30, 1998 ____ standard registration - postmarked on or before July 31, 1998 ____ on-site registration - to be paid in Prague Student registration fee does not include conference party. ROOMS RESERVATION IN HOTEL KRYSTAL: We do not arrange any further hotel reservations (since July 16). We do not arrange reservation in other hotels. Method of Payment __________ Registration fee $___ Party for student or spouse $20 $___ TOTAL $___ Acceptable methods of payment: Credit Card (Mastercard *or* VISA only) Money order (this is not bank wire transfer) Institutional check Personal check Make checks payable to ACA'98. All payments must be in US dollars (strongly preferred) or include US $15.00 extra to cover currency exchange. Czech participants, to avoid exchange losses, may pay directly in Kc in present official CNB exchange rate ______ Kc/US$ (date _____________) by wire transfer (ask at aca98@siduri.fjfi.cvut.cz for details). Return completed registration form with payment to: ACA'98 Conference FAX: +1 (505) 277-5505 Cotopaxi (credit cards only) 1801 Quincy, SE OR Albuquerque, New Mexico Email: aca98@siduri.fjfi.cvut.cz USA 87108-4427 (credit cards only) (Please SEND A NOTE by email to aca98@siduri.fjfi.cvut.cz no matter how you send the payment as a confirmation!!! All registrations will be acknowledged by email.) For Credit Card Payment: Card Type ____________________ # ________________________ Exp. Date ________ Card Holder Name (print) _____________________ Signature ___________________ Credit Card Mailing Address ________________________________________________ (Email registration is preferred and does not require a signature)