Ada-Belgium'99 Seminar Registration
_____________________________________________________________________________

Please mail to                                  or fax to
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Ada-Belgium'99 Secretariat                      + 32 (0)16-32.79.96
Attn. Prof. K. De Vlaminck
c/o Department of Computer Science
Katholieke Universiteit Leuven (K.U.Leuven)
Celestijnenlaan 200A
B - 3001 Leuven (Heverlee), Belgium

Personal Information
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Last name  __________________________   First name  _________________________
Job title / Occupation  _____________________________________________________
Company / Institution  ______________________________________________________
Address  ____________________________________________________________________
_____________________________________________________________________________
Postal code _________________________   City  _______________________________
Country  ____________________________   E-mail  _____________________________
Telephone  __________________________   Fax  ________________________________

I want to register for the Ada-Belgium'99 Seminar that will take place at the
"Groot Begijnhof" in Leuven on November 19, 1999.

I will pay the following registration fee                       (Please tick)
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___  5 000 BEF as Ada-Belgium member     ___ I am joining Ada-Belgium also(*)
___  7 000 BEF as non Ada-Belgium member
___      0 BEF as full-time student & Ada-Belgium member (without lunch)
___      0 BEF as full-time student [*]                  (without lunch)
Institution  ____________________   Please append a copy of your student card

Moreover                                         (Please tick all that apply)
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I would like to receive the following copies of the Walnut Creek Ada and
Software Engineering double CD-ROM sets, and will add the corresponding
amount to my payment:
___    0 BEF for the update set (Oct 1999), paying participants and members
___  200 BEF for the update set (Oct 1999), students in category [*]
___  200 BEF for the base set (Nov 1998) as distributed at Ada-Belgium'98

___  Please send me accommodation information

Payment information                                    (Please tick one item)
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I agree to pay the above specified fees to Ada-Belgium vzw/asbl
___  to account number 979-3829669-17 (Argenta), or
___  to account number 409-9054291-64 (KBC)
mentioning "Ada-Belgium'99 Seminar" and if applicable "plus '99 membership"


Signature  __________________________   Date  _______________________________


(*) 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 1999 and pay the appropriate fee.

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'99 Home Page.

Last update: 1999/10/14.