Sirocco 2001 Registration Form  /   Please make sure to provide all the needed information.
If you have any question please contact  comellas@mat.upc.es
To register,  please fill out the following form and fax it to +34 93 401 5981

Last Name: __________________________________________ First Name: __________________________________ Sex: _____
Affiliation: _____________________________________________________________________________________________________________
Address:    _____________________________________________________________________________________________________________
Phone: _____________________________ Fax: _________   ____________ E-mail: ___________________________________________________

I plan  to attend  also  IWIN'2001                        YES [  ]      NO [  ]             Vegetarian:      YES [  ]    NO [  ]
Student (an official certificate will be asked):        YES [  ]      NO [  ]
Accompanying person                                          YES [  ]      NO [  ]  (please print, fill and fax the form for accompanying person)

Desired partner for room sharing (if student): _____________________________

Expected arrival:_____________________                            Expected departure:_____________________
 
 
NORMAL FEES Early registration (before May 15,  2000) Late registration 
SIROCCO 2001 (50.000 PTA -  300 EURO) (60.000 PTA - 360 EURO) 
SIROCCO'01 and IWIN '01 (80.000 PTA - 480 EURO) (90.000 PTA - 540 EURO)
 
STUDENT FEES Early registration (before May 15,  2000) Late registration
SIROCCO 2001 (40.000 PTA - 240 EURO) (45.000 PTA - 270 EURO) 
SIROCCO '01 and  IWIN 2001 (65.000 PTA - 390 EURO) (70.000 PTA - 420  EURO)

Form of payment       CASH (on site only using PTA) [  ]          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 :