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


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: