1994 Ada-Belgium Seminar Registration Form

1994 Ada-Belgium Seminar Registration
=====================================

Mail or fax to: Prof. R. Devillers
                1994 Ada-Belgium Seminar Secretariat
                CP 202 Campus Plaine ULB
                Boulevard du Triomphe
                B-1050 Bruxelles  Belgium
                Tel: (+32)02/650.5611 or 5614
                Fax: (+32)02/650.5609

Personal Information
--------------------

Name:                        First name:
Company:
Address:


Postal Code:                 City:
Country:                     E-mail:
Telephone:                   Telefax:

I want to register for the 1994 Ada-Belgium Seminar that will take place
in Brussels on November 23, 1994.

I will pay the following registration fee:
  o  3300 BF  as an Ada-Belgium member.
  o  2000 BF  as an Ada-Belgium member, without J. Barnes' book.
     (N.B. if you are not yet an Ada-Belgium member but would like to
     become one, please join an Ada-Belgium membership application form,
     and pay one of the above fees).
  o  4500 BF  as a non Ada-Belgium member.
  o  3000 BF  as a non Ada-Belgium member, without J. Barnes' book.
  o  1200 BF  as a full time student.
     Institution (please join a copy of your student card):

  o  200 BF   as a full time student, without J. Barnes' book.
     Institution (please join a copy of your student card):

Moreover
  o  I would like to receive a copy of the Walnut Creek Ada CDROM.
  o  I intend to give a short presentation (5 minutes at most)
     of (some of) the Ada-related activities of my company.

Signature:



Payment Information
-------------------
The registration fee should be deposited on the following bank account:
  Ada-Belgium V.Z.W.
  979-3829669-17
with reference: "1994 Ada-Belgium Seminar".

To the Ada-Belgium home page.