TSD 2002 Registration Fee
============================================================================

     [] VISA      [] MASTERCARD/EUROCARD      [] AMERICAN EXPRESS 

    Please note that the amount your card will be charged depends on the
    actual exchange rate.

        Please print this Text-Only Registration Form, sign it,
        and send it to:

                   Faculty of Informatics MU
                   TSD2002, Dana Komarkova
                   Botanicka 68a
                   602 00 Brno, Czech Republic       

	FAX: +420-5-4121 2568

        When sending postal mail, please ensure that you use a service
	which is reliable and not notoriously slow from your country.
        When filling in the dates below, please write them legibly. 
		


    Cardholder's name:  _____________________________________________________

    Card no.: (print clearly and include all digits)


    ________________ - ________________ - ________________ - ________________  


    CVV: ___ ___ ___       (only for VISA, 3 digits, you can find it at the
                            reverse side of the card)

    CVC: ___ ___ ___       (only for Mastercard/Eurocard, 3 digits, you can
                            find it at the reverse side of the card)
    
    Address:               (only for American Express cards)

    _________________________________________________________________________

    _________________________________________________________________________

    _________________________________________________________________________
 


    Expiration: ________ / ________ / ________


    Date:       ______________________________


    Signature:  ______________________________


    Amount to be payed:  EUR _________________