INSCRIPTION FORM

International Meeting on Coding Theory and Cryptography 
(IMCTC, Medina 99) 

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PERSONAL DATA:

Surname: __________________________
First name: _______________________
Centre/ Department: __________________________
Mailing Address:__________________________
City:  __________________________
Province/State: __________________________
Postal Code/ZIP: __________________________
Country: __________________________
Telephone: __________________________
Fax: __________________________
E-mail address:__________________________

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Do you intend to give a talk?   YES__________  NO__________
If yes: 

Title _______________________________________________
Lenght: 20 minutes___ 40 minutes (survey talks)____ Other_______
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Registration fee: 25000 ESP

Remark: The registration fee includes lodging at the castle (Castillo de la Mota) the nights
of the 5th, 6th and 7th of September, and all the meals from breakfast on the 6th to lunch on the 8th (both included). 

The registration fee has to be paid by bank transfer to the following account:

Bank: Caja de Ahorros de Salamanca y Soria
Account number: 2104 0175 70 1100000039
Payable to: Universidad de Valladolid. General.
Concept: Inscripcion Congreso IMCTC Medina '99.