------------------------------------------------------------------------------- REGISTRATION FORM M F C S 2 0 0 3 28th International Symposium on Mathematical Foundations of Computer Science August 25 - 29, 2003 Bratislava, Slovakia http://www.mfcs.sk/ ------------------------------------------------------------------------------- Please, fill in (type or use block letters) and return this form together with a proof of payment to the Organizing Committee. For early registration the registration form must reach the Organizing Committee not later than July 7, 2003. For credit card payments please send the signed form by fax to ++(421) (2) 654 24 826. [ ] Mr. [ ] Ms. First name(s):........................................... Family name : ............................................................. Nationality : ............................................................. Affiliation : ............................................................. Address : ............................................................. E-mail : .......................................... [ ] Vegetarian meals Phone : ............................ Fax : ............................ Expected Date of Arrival: .................................................... Expected Date of Departure: .................................................. Any Other Messages to the Organizing Committe: ............................... .............................................................................. .............................................................................. Registration before July 7 after July 7 regular [ ] 400 EUR [ ] 440 EUR EATCS member [ ] 365 EUR [ ] 405 EUR IT-STAR [ ] 355 EUR [ ] 395 EUR Accommodation Double room Single room Sorea standard (6 nights) [ ] 115 EUR [ ] 190 EUR Sorea business (6 nights) [ ] 180 EUR [ ] 330 EUR Druzba (6 nights) [ ] 80 EUR [ ] 120 EUR Accompanying persons number of accompanying Sorea standard Sorea business Druzba persons ............x [ ] 265 EUR [ ] 330 EUR [ ] 230 EUR Total amount: ....... EUR [ ] Please, charge my credit card [ ] VISA [ ] EUROCARD/MASTERCARD Card No.: .................................. Exp. Date: ................ Name: .................................................................... Address: ................................................................. Date: ........................ CVC-2 code: ............................... Signature: ............................................................... CVC-2 code are the last three digits written on the back side of the card - see the slip with the Authorized Signature. [ ] I paid by bank transfer on ............... to the account given below: Beneficiary: Slovak Society for Computer Science Address: Mlynska Dolina, FMFI UK 842 48 Bratislava Slovakia Account #: 2623081336/1100 Bank: TATRA BANKA a.s., Bratislava Branch Vajanského nábr. 5 P.O. Box 9 810 06 Bratislava 16 Slovak Republic SWIFT Code: TATR SK BX Details of Payment: MFCS'03 - -------------------------------------------------------------------------------