Registration

Personal Data:

Title: Dr. Mr. Ms.

Status: Student Postdoctoral Fellow Professor Other

	     Surname: 		   Given name: 
	 Institution: 
Institutional Address (including city, province/state, postal/zip code, country):
		      
Mailing Address (if different from the above):
		      
    Office Telephone: 	       Home Telephone: 
		 Fax: 
      E-mail address: 
 WEB address: http:// 

Please send your abstract to wireless.RCM2@CRT.UMontreal.CA.
For submission guidelines, consult the workshop's web site.

Registration Fees

200 $ CDN, Faculty member 200 $ CDN, Industrial researcher 60 $ CDN, Full-time student 60 $ CDN, Postdoctoral Fellow   Lunch is included.

Method of payment:

Cheque payable to Centre de recherches mathématiques (drawn on Canadian or US bank only)

International money order payable to Centre de recherches mathématiques (drawn on Canadian or US bank only)

Credit card: VISA

Credit card: MasterCard

If you pay by cheque or money order, or if you prefer to send your credit card info. by post, our postal address is:

	Centre de recherches mathématiques
	Université de Montréal
	Case postale 6128, succursale centre-ville
	Montréal (Québec) H3C 3J7

Information about credit card:

      Name of Cardholder: 
		  Number: 
	     Expiry Date: 

Accommodation:

Would you like the CRM to book accommodation for you?	Yes	No

	  First choice: 
	 Second choice: 

Occupancy:	Single	Double

    Date of arrival at hotel: 
    Time of arrival at hotel: 
Date of departure from hotel: 

Important: In order to guarantee your hotel reservation,
please enter credit card information in the section "Method of payment",
even if you have chosen a different payment method.

If you have completed this form...