Euler 2004 Workshop Registration Form

First Name:     Last Name: 

Email address: 

Postal address:

Phone Number: 

Affiliated Organization: 

 

Workshop Costs

Registration includes attendance for both days, lunch on both days, a copy of the proceedings, and an evening meal on the 22nd September.
Registration is £160. Extra Dinner Tickets are £55 each.

 
Workshop Registration Number of Extra Dinner Tickets

 

Payment Methods
       

         Issuer

 Credit Card Number Expiry Date Cardholder's Name

 

  (Switch/Solo only) Issue Number: OR Start Date:

Security Number:

    On a Visa or MasterCard or Discover the Security Number is the last 3 digits of the number printed on the signature strip. On American Express Cards, it is a 4-digit number that appears above the end of the card number.
Other payment arrangements. Please give details:

Contact: euler2004@kent.ac.uk