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