Optimization Days 2002
Registration Form

Please print this form, fill it and send it at the address below, along with your payment.
Optimization Days 2002
C.R.T., Université de Montréal
C.P. 6128, succursale Centre-ville
Montréal (Québec) Canada H3C 3J7

If you pay by credit card, you may also send this form by fax at (514) 343-7121.

 
Payment Mode

  ___ check *

  ___ money order *
  ___ Visa

  ___ MasterCard
  _____________________
 		  Card Number
  _____________________
 		  Expiry Date
  _____________________
 		  Signature
 

Registration Fee ($ CDN):

____   190 $, until March 31, 2002
____   240 $, after March 31, 2002
____   30 $, student
GST Registration No. : R108160995 / PST: 1006011132
*  Checks and money order must be made payable to C.R.T., Université de Montréal, in Canadian dollars and issued from a Canadian bank.


Attendee

Name _______________________________________________________________________
 
Affiliation _______________________________________________________________________
 
Address _______________________________________________________________________
 
   _______________________________________________________________________
 
City ______________________________
 		 Prov./State ______________________________
 
Country ______________________________
 		 Postal code ______________________________
 
Phone ______________________________
 		 Fax ______________________________
 
Email _______________________________________________________________________