Ada-Belgium'98 Seminar Registration
________________________________________________________________________

Please mail to                                  or fax to
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Ada-Belgium'98 Secretariat                      + 32 (0)2 650.56.09
Attn. Prof. R. Devillers
c/o Universite' Libre de Bruxelles (U.L.B.)
Boulevard du Triomphe / Triomflaan
Campus de la Plaine, CP 212
B - 1050 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  ____________________________

I want to register for the Ada-Belgium'98 Seminar that will take place
at the U.L.B. in Brussels on December 04, 1998

I will pay the following registration fee         (Please tick one item)
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___  4 000 BEF  as a current Ada-Belgium member
___  4 000 BEF  as a new 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 for 1998 and pay the appropriate 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                                    (Please tick all that apply)
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___  I would like to receive a copy of the Walnut Creek Ada CD-ROM set
___  Please send me accommodation information

Payment information                               (Please tick one item)
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I agree to pay the appropriate registration fee to Ada-Belgium VZW
___  to account number 979-3829669-17 (Argenta)
                                      if paying from inside Belgium
___  to account number 409-9054291-64 (Kredietbank)
                                      if paying from outside Belgium
mentioning "Ada-Belgium'98 Seminar"


Signature  _________________________   Date  ___________________________

This form is also available as a Microsoft Word Document to get a "nicer" printout.

To the Ada-Belgium home page. To the Ada-Belgium'98 Home Page.

Last update: 1998/11/05.