Sirocco 2001 Registration Form for Accompanying Person
This form must be signed by the attendant to Sirocco 2001, NOT by the accompanying person.
Please make sure to provide all the needed information.

If you have any question please contact  comellas@mat.upc.es
To register an accompanying person, please fill out the following form and  fax it  to +34 93 401 5981

Name of the attendant to Sirocco 2001: _____________________________________________________

Number of nights:___________ (7000  PTA  per  night)

Expected date of arrival:__________________________________________________

Social dinner     YES [  ]      NO [  ]  (6.000 PTA)

Tickets for lunches and dinners can be purchased on site, by paying 3.000 PTA  per ticket.

Form of payment       CASH (on site, only using ITL) [  ]          CREDIT CARD [  ]         BANK TRANSFER [  ]
 

Information for bank transfer paymen t:
Bank: La Caixa, Trias Giro 11-13, 08034 Barcelona, Spain
Name Account: SIROCCO2001
Swift Code: CAIXESBB
International Bank Account Number: 2100-0655-78-0200251698

For credit card payment, you *must* provide the following credit card information, now:              Visa: [  ]           Master: [  ]

Credit Card No.: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expiration Date (mm/yy): __ __ / __ __
Name of Card Holder: (use exact spelling)____________________________________________________________________________
 

Please sign:

____________________________________________________________________________