ICMP2003 Registration Form
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K.I.T.
Congressos e Incentivos, Lda.
Ref.: "XIV International Congress on Mathematical Physics"
Rua Pedro Monjardino, Lte 11, 1 Dto
1600-892 Lisbon, Portugal

  Phone: +351 217 220 010  -  Fax: +351 217 220 019  -  Email: mpinto@kit.pt

Please fill the fields by hand or using your word processor. After filling
the form, please send it to the fax number or email address above.
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Form of address (mark yours):      Mr.[ ]   Mrs.[ ]   Dr.[ ]   Prof.[ ]

Last name: __________________________  First name: ____________________________

Email: ___________________________________________________________

Institution: _____________________________________________________

Position: ________________________________________________________

Street and no. ________________________________________________________________

ZIP code: ___________________________  City/Town: _____________________________

Country: ______________________________________________________________________

Telephone number: ___________________  Fax number: ____________________________

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REGISTRATION FEES "XIV International Congress on Mathematical Physics".
Values in EURO.  Please mark your option.

                     Early*           Standard*                  Late
                 (until Feb 28)   (Mar 1 to Jun 28)   (Jun 29 to the congress)
  Participants      140,00[ ]         180,00[ ]                200,00[ ]
  IAMP Members      120,00[ ]         150,00[ ]                160,00[ ]
  Students          100,00[ ]         110,00[ ]                120,00[ ]


REGISTRATION FEES "Young Researchers Symposium".
Values in EURO.  Please mark your option.

                     Early*           Standard*                  Late
                 (until Feb 28)   (Mar 1 to Jun 28)   (Jun 29 to the congress)
  Participants      60,00[ ]           75,00[ ]                 90,00[ ]
  IAMP Members      50,00[ ]           60,00[ ]                 80,00[ ]
  Students**        40,00[ ]           50,00[ ]                 70,00[ ]

 *Please note that the reduced fees apply only if both the registration
  form and payment have been received until the dates above referred.
**Up to 27 years old.

Total: _________________

Please do not forget to keep a copy of the booking forms for your own control.





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TERMS OF PAYMENT

Please mark below which of the following three payments (cheque, bank transfer
or credit card) you have used for registration (in EURO only).

 [ ] Cheque payment
     Checks must be issued and sent to:    K.I.T.
                                           Congressos e Incentivos, Lda.
     Please add 15 EURO for                Ref.: "XIV International Congress on
     foreign checks to                     Mathematical Physics"
     cover bank charges.                   Rua Pedro Monjardino, Lte 11, 1 Dto
                                           1600-892 Lisbon, Portugal


 [ ] Bank transfer payment                 BBVA
                                           Av. Duque de Loulé, 130
     Please send us by mail the copy       1050-093 Lisbon, Portugal
     of your bank transfer order.          Swift Code: BBVA PT PL,
     You can also send it by fax           Nr. PT50 0019 0111 00200006883 50
     to the number +351 217 220 019.       Ref.: "XIV International Congress on
                                           Mathematical Physics"

     All costs of transfer must be paid by the transmitter.
     Please state the participant's name,
     address and the Ref "XIV International Congress on Mathematical Physics".


 [ ] Credit card:

     Mark yours:

      Visa[ ]   American Express[ ]   EUROCARD/Mastercard[ ]   Diners Club[ ]

     In case this is your method of payment, please send together with the copy
     of the credit card:

     Credit card no. ______________________ Expiring date: ____________________

     Billing address __________________________________________________________

     3 last digits on the back of the
     credit card (except American Express): __________

     Cardholder's name: _______________________________________________________

     I authorize K.I.T. to debit this credit card account in EURO for the total
     amount due only.  I also consent to K.I.T. debiting or crediting my credit
     card account with the amount of any subsequent change(s) to the items
     booked.


                 I confirm the above registration
                 and accept the conditions described in the present form.


 Sig. _________________________________________________________________________