PRELIMINARY REGISTRATION FORM


Title                       First Name   
Name          
Organization  
Department    
Address       
Postal Code        City        Country   
Telephone          Fax         E-mail    

Payment enclosed to the amount of US $ (please enclose a copy of the bank draft) remitted to:

Progress & Business Foundation, Bank BPH O/IV Krakow, Acc # 10601389 - 705455 - 27000 - 50101

Please charge my credit card (credit card orders must be signed and faxed or mailed)

              Cardholder's name   
                 Visa
                 EUROCARD/MASTERCARD
                 DINERS CLUB
                 JCB
                 Card number        
		 Expiration date 
                 Date               Signature ..........................        
I would like to present a paper in a
                  refereed
                  unrefereed section
                  an abstract is enclosed
Title of the paper: 
I would like to receive further information by 
                  e-mail
                  fax
                  ordinary mail

Accomparsing Person Fee includes: Welcome reception, Social dinner And Social program - 70 US $

Excursion on Saturday 10. October - 50 US $

klempka@tsunami.kaniup.agh.edu.pl