REGISTRATION FORM 
Logic Colloquium 2006
Thursday July 27, 2006 until Wednesday August 2, 2006

--- Please tick the appropriate boxes ---	   

Name and address details	

First Name:  _________________________________	Female/male*

Surname:     _________________________________

Institution: _________________________________

Address:     _________________________________     

             _________________________________     	

State / Province:    _________________________

Country and ZIP-code:_________________________   
	
Phone number:        _________________________  		

Fax number:          _________________________ 

E-mail:              _________________________  



I will be accompanied by:

First Name:  _________________________________	Female/male*

Surname:     _________________________________  

Phone number:_________________________________  		

Fax number:  _________________________________ 

E-mail:      _________________________________  



O I/We intend to participate in the welcome reception (free of charge)
  on Thursday evening July 27

	
Registration details
====================		

O Participant
  Early registration fee (before May 1)		Euro 190	
  Late registration fee (after May 1)           Euro 240
  Registration fee for Plenary Invited Speakers / Tutorial Speakers / 
  PC members                                    Euro   0

O Excursion					Euro 65

O I want to take part in the conference lunches on Thursday, Friday,
  Monday, Tuesday and Wednesday (the lunch on Saturday July 29 is
  included in the regsitration fee)
						Euro 62.50 


O Accompanying person				Euro 110


							

O The total amount of Euro ________ is transferred to the Conference Agency
  by bank transfer: 

  Account number 53 77 28 783 of the 
  ABN/AMRO Bank, 
  P.O.Box 2059, 
  3500 GB Utrecht, 
  the Netherlands. 
  BIC number: ABNANL2A 
  IBAN number: NL92ABNA0537728783.
              
  Please make the payment under reference of your name and the number 900028.
	
O Please charge my 
  Euro/MasterCard for        Euro_______
  American Express Card for  Euro_______
  Visa Card for              Euro_______
	  		
Card number:
[  ][  ][  ][  ][  ][  ][  ][  ][  ][  ][  ][  ][  ][  ][  ][  ]   


Expiry date:  ____ / _____ 		
Card Validation Code (for Euro/MasterCard only)  ______
		
Name card holder:_________________________ 




Signature:       _________________________
	
Registration will not be valid until the required fee has been
received. All payments should be made in Euros




Accommodation details
=====================
Please note: Prices are subject to change

O Apollo hotel		
  O Single Euro 75	O Double Euro 98

O Belvoir hotel	
  O Single Euro 102	O Double Euro 117

O Erica hotel 		
  O Single Euro 80	O Double Euro 95

O Mercure hotel	
  O Single Euro 110	O Double Euro 125

O Val Monte hotel	
  O Single Euro 106	O Double Euro 120

NB City tax is *not* included in these rates.
	
Date of arrival   ____________ Date of departure ____________




O I do not need any accommodation

Please note: In case of no show the first night will be charged to
your credit card.


	
Special requirements:
====================
Do you have any food intolerance, special dietary requirements,
allergies or any particular physical conditions?







It is also possible to send this form by fax to:

Ms. Jacqueline Berns
Fax +31 24 356 79 56