"Austrochip 2006" Registration Form ----------------------------------- I would like to register for the "Austrochip 2006" conference on October 11, 2006 at the "Messezentrum Wien", Messeplatz 1, 1020 Vienna, Austria. The registration fee includes the conference proceedings, breakfast, lunch and coffee breaks (the optional conference dinner is not included, see below). ---------------- Please complete: ---------------- Last Name: First Name: Degree: Institution/Company Name: Street: Zip Code: Town: Country: ------------------- Please mark with *: ------------------- [ ] Regular conference fee registration by September 27, 2006: 70 Euro registration after September 27, 2006: 90 Euro [ ] Conference fee for students registration by September 27, 2006: 30 Euro registration after September 27, 2006: 50 Euro [ ] I would like to participate at the optional conference dinner additional fee for registration by September 27, 2006: 10 Euro additional fee for registration after September 27, 2006: 15 Euro Note: Students have to show their students ID at the conference location ----------------------------------------------------------------------------- Please send this e-mail to contact@austrochip.at and make a bank transfer to the bank account shown below. Please note, that canceling of your registration is not possible after October 6, 2006. For further information please contact the "Austrochip 2006" conference organization either by phone +43-3334077-292 or via e-mail contact@austrochip.at Bank Account Holder: "Oesterreichischer Verband fuer Elektrotechnik - OVE" Bank: "Bank Austria Creditanstalt" Bank Identification Code ("Bankleitzahl"): 12000 Bank Account Number: 00432842300 Note to Payee: "Austrochip 2006" ----------------------------------------------------------------------------- End of this form