Conference Registration Fax-Post Form

You may either print this form, complete it, and mail (not e-mail) or fax it. Or, you may directly type in your information on this form, print it, and then mail (not e-mail) or fax to:

Working Conference on User Identification & Privacy Protection
Att: Birgitta Olsson
Stockholm University / Royal Institute of Technology
Electrum 230, SE- 164 40 KISTA, SWEDEN

Phone: +46 8 161691
Fax: +46 8 7039025

Refer to Registration Information for complete conference description and price information.

First Name
Family Name
Job Title
Employer
Address 1
Address 2
City + State or Province
Country
Zip or Postal Code
 
IFIP Member Yes No

Technical Commitee: Working Group:

Telephone Country Code: Number:
Fax Country Code: Number:
Email

Official Conference Dinner

Please enter the number of people that will attend the Social Event (not included in Registration Conference Fees (Fee SEK 350 per person).

Method of payment

Credit Card:

with Credit card

Please charge my credit card:
VISA Mastercard
Card nummer:
. . . 		Date of expiry : Month/year
/
Name of Card Holder:

Your credit card will be charged SEK 3000 (SEK 1500 if you are eligble for discount), plus SEK 350 per person attending the social event.

Bank Transfer or Postal Giro:

Attach proof of payment in this space (you will have to pay BEFORE sending us this form, unless you are using the credit card payment method above).
  • The postal giro account number is: 15657-0 (mainly for payments in within Sweden)
  • The bank account number is: 5439-10-013-06. The name of the bank is SEB. The address is 10640 STOCKHOLM, SWEDEN. The SWIFT address is ESSESESS.
  • When paying via bank transfer or postal giro, you MUST enter YOUR FULL NAME and the following PROJECT NUMBER on your payment document: 1932311

Special wishes, suggestions, problems and questions :

[ Print this and FAX/POST it. You will receive a confirmation letter from us! ]