[ ONLINE CREDIT CARD REGISTRATION ]

If you have any questions regarding filling out this form, please contact Birgitta Olsson at +46 8 161691 or via 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

Social Event

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

Credit Card information

Please note: Data is NOT encrypted!

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.

Special wishes, suggestions, problems and questions :