Credit Card Form

IAG 2001 Scientific Assembly
2-7 September, 2001 - Budapest, Hungary


After filling in and printing out this form, please send it
to the IAG 2001 Secretariat by fax or via mail:

IAG 2001 Secretariat, c/o Viktor Richter
Computer and Automation Research Institute, HAS
Kende u. 13-17, H-1111 Budapest, Hungary
fax: +361 386 9378

 
Personal Data
Family name   Given name
Phone   E-mail

 
Credit Card Data
American Express EuroCard/MasterCard  Visa
Card number   Expiry date
Cardholder's name

 
 
Date Signature ...............................................................