HCI-ET Applications Form

Surname:....................................................................................................

Firstname:..................................................................................................

Affiliation:...................................................................................................

Address:....................................................................................................

E-mail:.......................................................................................................

Phone:.......................................................................................................

Fax:...........................................................................................................

Registration

Regular: 180 USD

Joint registration for PEG’97 and HCI-ET:

Early registration: 340 USD
Onsite: 390 USD

Total for registration ...........................................



Accommodation

Please reserve for me:

No. ............. single room/s (50 USD per day)
No. ............. double room/s (35 USD per day per person)

Total for accommodation .......................



Payment

TOTAL: ............... USD

Please mark your choice:

On site in cash ....................

Bank transfer (for early registrations) ....................
To: ING Bank, Sofia Branch,
7, Levski Str.,
Sofia 1000, Bulgaria
(SWIFT code: INGBBGSF)
Account No. 1100118914 VIRTECH Ltd. (for HCI-ET)

Any special requests: (food preferences, etc.): ...................................... ............................................................................................................ ............................................................................................................