1995 Ada-Belgium Seminar Registration Form

1995 Ada-Belgium Seminar Registration
=====================================

Mail or fax to: Prof. R. Devillers
                1995 Ada-Belgium Seminar Secretariat
                c/o Universite' Libre de Bruxelles (ULB)
                Boulevard du Triomphe / Triomflaan
                Campus de la Plaine, CP 202
                B-1050 Brussels, Belgium
                Fax +32-2-650.56.09

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

Name:                        First name:
Company / Institution:
Address:


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

I want to register for the 1995 Ada-Belgium Seminar that will take place
in Leuven on December 18, 1995.

I will pay the following registration fee:
  o  4000 BEF  as an Ada-Belgium member.
     (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 the above fee).
  o  5000 BEF  as a non Ada-Belgium member.
  o     0 BEF  as a full time student (without lunch).
     Institution (please join a copy of your student card):

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

Payment Information
-------------------
I agree to deposit the appropriate registration fee on the following
bank account:
  Ada-Belgium V.Z.W.
  979-3829669-17
with reference: "1995 Ada-Belgium Seminar".

Signature:

To the Ada-Belgium home page.

Last update: 95/11/29.