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Please note that in the registration form below, a misleading formulation
found within the original form was clarified. Basic accommodation is
INCLUDED in the registration fee.
Unless shared accomodation has been requested, the accomodation provided
is single person in a double-bed room. No extra accomodation cost is
therefore required for one accompanying person. If more rooms are needed,
please add the accomodation cost for each double room requested.
The registration fee includes breakfast and lunch for participants of the
conference. Additional breakfasts and/or lunches for accompanying persons
can be oredered at the conference registration desk during the
conference.
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REGISTRATION FORM
GOEDEL'96
LOGICAL FOUNDATIONS OF MATHEMATICS, COMPUTER SCIENCE AND PHYSICS
August 25-29, 1996, Brno, Czech Republic
IMPORTANT
* Completed registration forms should NOT be e-mailed. Paper
copies should be sent to the correspondence address (at the
bottom of this form).
* The registration form can only be accepted if accompanied by
full payment.
* One participant per registration form.
REGISTRATION DETAILS:
Prof/Dr/Mr/Mrs/Ms/Miss: _______________________________________
Surname: ____________________________________________________
Given Name: __________________________________________________
Position/Title: _______________________________________________
Department: __________________________________________________
Organisation: _________________________________________________
Address: ______________________________________________________
State: _______________________________________________________
Postcode: ____________________________________________________
Country: _____________________________________________________
E-mail: _______________________________________________________
Business Telephone: (_____) ____________ Fax: (____) __________
Preferred Name for Badge: _____________________________________
SPECIAL REQUIREMENTS:
Special Diet: ________________________________________________
Other: _______________________________________________________
ACCOMMODATION: Please indicate if required (tick):
( ) University guest hotel
Accomodation Type:
( ) Single Person in Double Room (no sharing) - $20 for one night
$20 per night; five nights INCLUDED in registration fee
From: __________ To: ___________ # of nights: ________
Insert only ADDITIONAL cost for extra nights: TOTAL : $ ________
( ) Double (2 sharing one room)
$50 for one person sharing a room for 5 nights
From 25.8. to 29.8. (5 nights) : $50
Room sharing prefered with: ___________________
Sorry -- no additional nights can be guaranteed.
( ) Reduced full-time student conference fee --
accomodation for four night included in the
reduced fee package, see below.
( ) Hotel *** "Continental"
Reservation required:
From: __________ To: ___________ # of nights: ________
Price approx. $70 per night.
Reservation required before June 1, 1995.
Payment details will be sent separately.
DEDUCT $100 from your registration fee when choosing this.
Arrival: Departure: Arrival time:
REGISTRATION FEES Received Received TOTAL
by after
21/3/1996 21/3/1996
Members of ( ) KGS, ( ) ASL, ( ) EACSL, ( ) IUHPS/DLPMS, ( ) CSIS (tick one)
indicate membership number: _________________
Conference Fee $350.00 $380.00 $ _______
Conference Fee shared room $300.00 $330.00 $ _______
Conference Fee without accom. $250.00 $280.00 $ _______
Others:
Conference Fee $380.00 $400.00 $ _______
Conference Fee shared room $330.00 $350.00 $ _______
Conference Fee without accom. $280.00 $300.00 $ _______
Full-time student package:
Reduced conference fee covering
conference attendance and five
nights in shared room: $140.00 $190.00 $ _______
Reduced student fee does not include conference proceedings copy.
Attach written statement your university certifying
your full-time student status.
Excursion: $30 per person; # of persons: _________ TOTAL: $ ________
TOTAL TO BE PAYED.......................................... USD $ ________
METHOD OF PAYMENT (All payments in US dollars)
( ) A Credit Card
Tick Card Type: ( ) VISA
( ) MC/EC
Card no. ________________ Expiration ____/____
Cardholder's Name: ________________________________
Cardholder's Signature ______________________________
( ) B Bank Cheque/Eurocheque payable in US dollars to "Faculty
of Informatics, Masaryk University" (enclosed)
( ) C Bank transfer to:
Bank: Komercni banka Praha, branch Brno
Account holder: Masaryk University
Account Number: 85 636-621/0100
Date of transfer:
(copy of bank transfer confirmnation enclosed)
Send completed form with you payment to the following address:
Dr Jiri Zlatuska
GOEDEL'96
Faculty of Informatics, Masaryk University
Botanicka 68a, CZ-602 00 Brno, Czech Republic
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A limited number participants from economically severely handicapped
countried can be supported by the organizers by allowing registration
for student fee. Send your application for financial assistance
electronically to , or to the above address, if
electronic connection cannot be used.