Ada-Belgium'97 Seminar Registration
________________________________________________________________________

Please mail to                                  or fax to
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   Ada-Belgium'97 Seminar Secretariat              + 32 (0)2 773.79.30
   c/o Trasys
   Attn. Mr. Guido Duerinckx
   7 av. Ariane
   B - 1200 Brussels, Belgium


Personal Information
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Name  __________________________   First name  _________________________

Job title / Occupation  ________________________________________________
Company / Institution  _________________________________________________
Address  _______________________________________________________________
________________________________________________________________________
Zip code  ______________________   City  _______________________________
Country  _______________________   E-mail  _____________________________
Telephone  _____________________   Telefax  ____________________________


YES, I want to register for the Ada-Belgium'97 Seminar that will take
place at Trasys in Brussels on November 28, 1997


YES, I will pay the following registration fee    (Please tick one item)
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___  4 000 BEF  as an Ada-Belgium member
                     Note: If you are not an Ada-Belgium member yet, but
                     you would like to become one, please mail or fax an
                     Ada-Belgium membership application form and pay the
                     above fee
___  6 000 BEF  as a non Ada-Belgium member
___      0 BEF  as a full-time student   (without lunch)
Institution  _________________   Please join a copy of your student card


Moreover
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___  I would like to receive a copy of the Walnut Creek Ada CD-ROM set
___  I would like to receive a copy of the Discovering Ada CD-ROM
___  Please send me accommodation information


Payment information                 (Please tick one item)
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YES, I agree to pay the appropriate registration fee to Ada-Belgium VZW
___  to account number 979-3829669-17 (Argenta), or
___  to account number 409-9054291-64 (Kredietbank),
     if paying from outside Belgium
mentioning "Ada-Belgium'97 Seminar"



Signature  _________________________   Date  ___________________________

This form is also available as a Microsoft Word Document.

To the Ada-Belgium home page. To the Ada-Belgium'97 Home Page.

Last update: 97/11/04.