ICATM'98 Registration Form

Please mail the complete Registration Form to :
Pascal LORENZ / ICATM'98
IUT/GTR - 34 rue du Grillenbreit - 68008 Colmar, France
Phone : 33 (0)3 89 20 23 66   Fax : 33 (0)3 89 20 23 59
Email : lorenz@colmar.uha.fr

Title: _______ First Name: _____________ Last Name: ______________________

Institution: ___________________________________________________________

Street Address: ________________________________________________________

City: __________ State: ____________ Zip: ___________ Country: ____________

Phone: ____________________________ Fax: ______________________________

Email : ____________________________

Means of transport : Car __ Train __ Plane (from Strasbourg) __ Plane (from Mulhouse) __

Arrival Date :     ____ June 1998 at _____
Departure Date :   ____ June 1998 at _____

Conference Registration Fees:

The Full registration fees include: attendance to the Symposium, coffee breaks, 3 lunches, the reception, the gala dinner and the preprints.

Academic rate:

IEEE, SEE Member         2400 FF   _________FF
(Membership # __________)

non IEEE member         2600 FF   __________FF

Industry rate:           4000 FF   __________FF

Extra Conference Proceedings (FF 400):       __________FF

Social and Cultural Activities

Haut-Koenigsbourg, June 22     300 FF x ___ pers = ____ FF
Eco-museum, June 23       300 FF x ___ pers = ____ FF
Colmar museums, June 24       100 FF x ___ pers = ____ FF
Extra gala dinner ticket, June 23     300 FF x ___ pers = ____ FF
Extra lunch ticket (Colmar)       60 FF x ___ = ____ FF

                 Total French Francs   _________

Payment of Fees:

__ By Foreign Check in French Francs to "Office du Tourisme de Colmar".

__ By Bank Transfer to: Caisse d'Epargne d'Alsace, Avenue de la République, 68000 Colmar - France. Bank code: 16705 - Counter code: 09017 - Account number: 04100568821 - Key: 23 - Account name: Office du Tourisme de Colmar - Transfer Swift : BFCE FR PP 317

__ By Credit Card:
     __ Mastercard
     __ Visa
     __ American Express

Card number: _________________________
Expiration date: _________

Signature: