                        SOFSEM 2001 Registration Form
                        -----------------------------

Please E-mail to   sofsem@dcs.fmph.uniba.sk
or mail/fax a signed copy to     

                   SOFSEM 2001,  
                   Attn. Mrs. M. Kozarova, INFOSTAT 
                   Dubravska 3 
                   842 21 Bratislava, Slovakia 

                   fax: (+421 2) 54 77 26 20, (+421 2) 54 79 14 63 


Given name:           ___________________    [] Mr.  [] Ms.

Middle initials:      ______________

Family name:          __________________

Affiliation: ______________________________________________________

Address:     ______________________________________________________

             ______________________________________________________
 
             ______________________________________________________

e-mail:      _____________________

fax:         _____________________

telephone:   _____________________
 

Type of Fee (S0,..., S3): ______

Single / Double Room: ___________

Vegetarian (Y/N):     _________

Accompanying Persons (number) : __________

Attendance at the Soft Computing Workshop (Y/N): ______

Soft Computing Workshop Proceedings (Y/N): _______ 

Attendance at the Electronic Commerce Systems Workshop (Y/N): ______

Electronic Commerce Systems Workshop Proceedings (Y/N): _______

Amount Paid:          __________________  

Date of Payment:      __________________

Details of Payment:   ___________________________________________


Special requirements: __________________________________________


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