Ada-Belgium'2000 Workshop Registration
________________________________________________________________________

Please mail to                       or fax to
--------------                       ---------
Ada-Belgium'2000 Secretariat         + 32 (0)2 725.40.12
Attn. Luc Bernard
c/o OFFIS - Aubay Group              or e-mail to
Weiveldlaan 41/32                    ------------
B-1930 Zaventem, Belgium             lbn@offis.be

Personal Information
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Name  __________________________   First name  _________________________
Job title / Occupation  ________________________________________________
Company / Institution  _________________________________________________
Address  _______________________________________________________________
________________________________________________________________________
Zip code  ______________________   City  _______________________________
Country  _______________________   E-mail  _____________________________
Telephone  _____________________   Telefax  ____________________________

I want to register, free of charge, for the Ada-Belgium'2000 Workshop
that will take place at the U.L.B. in Brussels on December 15, 2000.

Membership Status for 2000/2001                   (Please tick one item)
-------------------------------
___  I am an individual Ada-Belgium member
___  I am appointed contact person of a corporate Ada-Belgium member
___  I want to register as Ada-Belgium member for the year 2001
       (please mail or fax an Ada-Belgium membership application form
       and pay the appropriate fee)
___  I am not, nor do I want to register as, Ada-Belgium member
       (and hence am NOT entitled to the free Ada CD-ROMs and
        documention sets)

For Ada-Belgium Members Only                (Please tick all that apply)
----------------------------
___  I would like to receive a copy of the Ada and Software Engineering
       2 CD-ROM base set (November 1998)
___  I would like to receive a copy of the Ada and Software Engineering
       2 CD-ROM update 2 set (October 1999)
___  I would like to receive a copy of the documentation set of the
       Ada-Belgium'99 Seminar, theme "Ada 95 Works!"
       (as availability permits)
___  I would like to receive a copy of the documentation set of the
       Ada-Belgium'98 Seminar, theme "Concurrency & Real-Time"
       (as availability permits)

Signature  _________________________   Date  ___________________________

If you would like to have a "nicer" printout to fax or send via normal mail, this form will also be available shortly as a Microsoft Word Document.

To the Ada-Belgium home page. To the Ada-Belgium'2000 Workshop Home Page.

Last update: 2000/11/28.