Name |
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Address |
................................................................................................................ |
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E-mail |
............................................................................................................... |
University & Department |
............................................................................................................... |
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Accompanying person (s) |
(an extra registration fee of 200 SEK/adult) |
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.............................................................................................................. |
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............................................................................................................. |
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............................................................................................................. |
Arrival |
Date:.........................................................Time:..................................... |
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Means of arrival:..................................................................................... |
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Flight (train, bus, boat) coming from:........................................................ |
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Flight number:....................................................................................... |
Departure |
Date:.........................................................Time:.................................... |
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Means of departure:............................................................................... |
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Flight (train, bus, boat) to:...................................................................... |
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Flight number:........................................................................................ |
I shall be staying at: |
.............................................................................................................. |
I wish to participate in the sea excursion on June 7 |
yes........................... |
no.............................. |
Special food requirements |
............................................................................................................... |
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I wish to give a short talk (20-30 minutes) |
yes........................... |
no................................ |
Brief summary |
................................................................................................................ |
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................................................................................................................ |
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................................................................................................................. |
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................................................................................................................. |
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Payment: the registration fee is 800 SEK before April 30, 2001,
and 1000 SEK after that date. |
- I wish to pay by credit card (please use fax or mail to send
in the form):
|
VISA........................... |
number............................................ |
MasterCard.................. |
number............................................ |
Eurocard...................... |
number............................................ |
Cardholder........................................................................................ |
Expiry date........................................................................................ |
Signature............................................................................................ |
- I wish to use bank transfer:......................
|
Please pay the money to bank account nr 5439 10 323 09. Recipient
is Göteborg University. |
Swiftcode: ESSE SESS |
Skandinaviska Enskilda Banken, S-106 40 Stockholm |
Please refer to "Second Göteborg Conference in Harmonic
Analysis and Partial Differential Equations" and to ref
A3043. Do not forget to indicate your own name. |
- (For Sweden only!) I wish to use postgiro transfer:......................
|
Please pay the money to Swedish postal account nr 156 27-3 |
Swiftcode: PGSI SESS |
Postgirot bank, 105 06 Stockholm |
Please refer to "Second Göteborg Conference in Harmonic
Analysis and Partial Differential Equations" and to ref
A3043. Do not forget to indicate your own name. |
- I wish to pay cash on arrival (1000 SEK)..........................
|
- Please note that we cannot accept payment by cheque.
|