IS&N'99
                                       &
                                AGENT WORKSHOP
                               REGISTRATION FORM

Return (only by fax) registration form to:
Mrs. Merce Calvet
Dept. Arquitectura de Computadors
Universitat Politecnica de Catalunya (UPC)
Jordi Girona, 1-3, Modul D6
E-08034 Barcelona, SPAIN
Fax: (+34) 93 401 70 55

Please print or type:

Full Name ______________________________________________________________

Company/ Affiliation: _____________________________________________________

Mailing Address: _________________________________________________________

________________________________________________________________________

City/Country: ____________________________________________________________

Phone: _____________________________    Fax: _______________________________

E-mail: ____________________________ (We will confirm you the registration by e-mail)


CONFERENCE (27th-29th, April, Telefonica, Barcelona) registration fees (please put a tick against the appropriate box):
                                  Advance                     Late
                                  (Until 15th April, 1999)    (After 15th April, 1999)
Regular                           [] 450 EUROs                [] 540 EUROs     
University member                 [] 350 EUROs                [] 420 EUROs
First day entrance (27th April)   [] 150 EUROs                [] 180 EUROs	
Extra banquet ticket (27th April) []  60 EUROs                []  60 EUROs

The full conference fee includes admission to the technical sessions and showcase, proceedings book, reception, refreshment breaks, lunches and gala dinner.
The first day fee does not include the gala dinner.
The conference registration fee for IS&N'99 speakers has a discount of 10%.
IS&N'99 speaker	 [] Yes 	 [] No

Conference registration amount due:     EUROs ________(A)

WORKSHOP (26th April, UPC, Barcelona) registration fees (please put a tick against the appropriate box):
                     Advance                     Late
                     (Until 15th April, 1999)    (After 15th April, 1999)
Regular              [] 100 EUROs                [] 120 EUROs     

Workshop registration amount due:       EUROs ________(B)

TOTAL AMOUNT DUE:                       EUROs ________(A+B)

METHOD OF PAYMENT:

[] Bank Cheque in EUROs payable to UPC-ISN99 (please fax  a copy of the cheque and send us the original by postal mail to the address indicated above)

Credit Card:    [] VISA    [] MasterCard    [] American Express

Credit card number: ________________________________________   Expiration date: ____/ ____

Cardholder Name: __________________________________________


Signature: __________________________