IWSSIP 97
REGISTRATION FORM

Please return this form before April 4th to :

Prof. Marek Domanski
IWSSIP-97
Politechnika Poznanska, Instytut Elektroniki i Telekomunikacji
ul.Piotrowo 3a, PL 60-965 Poznan, Poland

Please type or print.

Family name ..........................  First name........................ Title ..........

Affiliation ........................................................................

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Short form of affiliation (as it will be indicated on a badge)

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Address ............................................................................

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Phone .............................................. Fax ...................................

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

CONFERENCE FEE
includes participation to IWSSIP 97 and a copy of the IWSSIP 97 Proceedings

Please indicate:                   TOTAL ............. ECU    or ............ $ US 

Payment of the registration fee should be made by bank draft made payable to

PTETiS Oddzial w Poznaniu, ul. Piotrowo 3a, 61-138 Poznan

The name of the bank:        PKO BP III Oddzial Poznan 
The address of the bank:     ul. Wierzbiecice 3, 61-529 Poznan, Poland 
Account number:              10204043 - 1182 - 270 - 1

Banking costs should be paid by the participant.
Please enclose a copy of the bank transfer receipt.

Date ..................................   Signature ........................................