================================================================= 4 May 94 INET'94 Prague, 15-17 June 1994 CONFERENCE REGISTRATION TEMPLATE Family Name: First Name: Prof__ Dr__ Mr__ Ms__ Internet Society Member: Title: Affiliation: Street Address: City: State: Postal Code: Country: Email: Fax: Telephone: Preferred Badge Name: Registered Accompanying Person(s): ---------------------------------------------------------------------- Conference registration fee MUST accompany this form and must be received before registration or accommodation can be processed. Keep a copy of this form for your records. Print or type information. Use one form per individual registration. RETURN COMPLETED FORM TO: Email: Fax: +42 2 243 10271 Tel: +42 2 332 2916 VC CVUT INET'94/JENC5 Conference Registration Office Zikova 4 166 035 Praha 6 Czech Republic Registration Fees: Before 15 May 94: Internet Society Member US$ 425 Non-Member US$ 475 (includes automatic membership) After 15 May 94: Internet Society Member US$ 475 Non-Member US$ 525 (includes automatic membership) On-site (after 6 June 94) Internet Society Member US$ 525 Non-Member US$ 575 (includes automatic membership) Accompanying Person US$ 115 (includes Opening Reception, Gala Dinner and Cocktail) Payment: Registration: US$: _________ Hotel Deposit (1 night) US$: _________ Total: US$: _________ All payments must be in United States Dollars. Bank transfer, international money orders and international credit cards (VISA, American Express and Master Card) are acceptable. Personal checks are not acceptable. Bank Transfer: Bank account No. 1412130287/0100, Komercni banka, Dejvicka 52, Praha 6, Czech Republic, with your name ____VISA ____MasterCard ____American Express Credit Card Number: Expiration Date: Billing Name on Card: Billing Street Address: Billing City: Billing State: Billing Postal Code: Billing Country: Signature authorization: (if sent by email, please type "YES") ---------------------------------------------------------------------- Special Needs: Meals: Other: Hotel Reservations Hotel reservations can be made by completing this form. cut-off date: 30 MAY 94 ________ Forum Hotel (US$ 153,-/single; US$ 168,-/double) ________ Panorama Hotel (US$ 125,-/single; US$ 142,-/double) ________ Union Hotel (US$ 95,-/single; US$ 112,-/double) ________ Patty Hotel (US$ 80,-/single; US$ 93,-/double) ________ ILF Hotel (US$ 50,-/single; US$ 65,-/double) ________ Kupa Hotel (US$ 30,-/single; US$ 40,-/double) Hotel extras should be paid directly to the hotel reception. Room Reservation Name ____________________ Sharing With: ____________________ Arrival Date: ___________/__________/1994 Departure Date: ___________/__________/1994 Please check one of the following: ___ l person ___ 2 persons, double beds ___ 2 persons, twin beds ___ Suites (extra cost) Do you have a special accommodation request (e.g., no-smoking room, disability or handicap)? _____________________________________ Accommodation Deposit: Your room reservation can be guaranteed by either of the following methods: 1. Complete the Credit Card Authorization section of this form. The INET'94/JENC5 Conference Registration Center can quarantee your room with the hotel by your credit card. This is the easiest way to quarantee your reservation. 2. Send one night's hotel fee along with the registration fee, if paying by check. =================================================================