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Please complete this form and return it to fax: +421 7 68279601
Or by e-mail to : iwssip99@ktl.elf.stuba.sk
First name: ___________________________ Last Name: _________________________
Title: ___________________________________________________________________
Organisation: ____________________________________________________________
Address: ________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Member Number (IEE,IEEE,EURASIP): ______________________________________
Phone: ______________ Fax: ________________ E-mail: ________________________
Date: ________________ Signature: _________________________________________
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Registration fee |
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IEE, IEEE, EURASIP members |
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Students |
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Banquet for accompanying persons |
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Payment:
Bank: Vseobecna uverova banka, branch Bratislava mesto, nam SNP
19, Bratislava, Slovak Republic
Account name: Teleconsult, Studenohorska 47, 84103 Bratislava
Account number: 1316425456/0200
SWIFT: SUBASKBX
Payment comment: IWSSIP99 conference fee
Ordering customer: please, specify the name of conference attendee