The 2nd IMACS Conference on APPLICATIONS OF COMPUTER ALGEBRA

July 17 - 20, 1996
Castle Hagenberg, Austria

Registration Form

Personal Data:
Participant: O Prof. O Dr. O Mrs. O Mr.
Family Name:
First Name:
Affiliation:
Address:
Country:
e-mail:
Phone:
Fax:

Accompanying Person(s):
Family Name:
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Registration
Participant till June 1,96 after June 1,96 Summary
IMACS members US $ 200,- US $ 230,- US $
non members US $ 215,- US $ 245,- US $
Acc. Person US $ 100,- US $ 130,-US $
Conference DinnerUS $ 50,- US $
TOTAL FEE US $

The registration fee includes:

I give a talk in the following session(s) (if any):
............................................................................................................................................................
............................................................................................................................................................

Remittance: Please check one of the following. All payments must be made in US $.
O I have remitted the above Total Fee on . . . . . . . . . . .(Date) to the account "IMACS-ACA", No. 26203, Raiffeisenbank Hagenberg, BLZ: 34151, A-4232 Hagenberg, Austria (Europe). I add a copy of the transfer form to confirm the remittance.
OI add a bank cheque for the above Total Fee payable to the account "IMACS-ACA" No. 26203, Raiffeisenbank Hagenberg, BLZ: 34151, A-4232 Hagenberg, Austria (Europe).
OI agree to remit above Total Fee by credit card
O American Express O Mastercard O VISA
Card Number:
Card holder's name:
Date:
Expiration Date:
Authorized Signature:
Date Signature