Registration form

ACM SIGOPS EUROPEAN WORKSHOP 2004

September 19-22, 2004, Leuven, Belgium.


First Name:
Last Name:
Organization:
Address:
Phone:
Fax:
E-mail:

ACM Member: Yes No ACM Number
SIGOPS Member: Yes No

Registration as: 1st author    2nd author    PC member
Other:         

Name and affiliation as you want them to appear on your badge:

Registration Fee

The workshop registration fee includes attendance at the workshop, one copy of the workshop proceedings, the reception on Sunday evening, the conference dinner on Tuesday evening, and lunches on Monday, Tuesday, and Wednesday. Also included is a visit to the brewery Stella Artois, organized on Monday.

PhD Student: Yes No    (If yes, include certificate from advisor)

I will attend the banquet: Yes No
Number of additional tickets (90 euro/ticket):

Early (before August 15) Late (after August 15)
ACM or SIGOPS member EUR 585 EUR 735
Non-member EUR 735 EUR 880
PhD Student EUR 410 EUR 515

Payment


I will transfer the amount of    EUR      to the SIGOPSEW 2004 account, number 432-0000011-57 of the K.U.Leuven, Krakenstraat 3, B-3000 Leuven, BELGIUM, quoting reference: HCG-ACMEW1-P3620.
The SWIFT number of the bank is: KREDBE BB (KBC-Bank, Bedrijvenkantoor Leuven, Interleuvenlaan 15C, B-3001 Heverlee, BELGIUM). Mention "Participation SIGOPSEW04" + your name.

I prefer payment by credit card:     VISA    MASTERCARD

Amount: EUR  
Name on Card:     Signature:
Card Number:
Expiration Date:     .................................


Date: .................................      Signature: ...........................................................

Please complete, print and sign this registration form before September 15, 2004 and return it by mail or fax to:


SIGOPSEW04 Registration,
Department of Computer Science, K.U.Leuven,
Celestijnenlaan 200A,
B-3001 Leuven,
Belgium

Fax : ++ 32(0)16 32 79 96