CONFERENCE ON

DISKS, PLANETESIMALS AND PLANETS

Puerto de la Cruz, Tenerife, Spain

January 24^th - 28^th 2000

REGISTRATION FORM

Name  ........:  
Example: Lastname, Firstname

E-mail .......:  

Institution ..:  

Address ......:  
Example: Street Nr, code City, State, Country

Phone ........:  
Example: +xx yy zzzzzz

Fax ..........:  
Example: +xx yy zzzzzz

I would like to give a presentation (or several presentations):
  Talk ...........: 
  Poster .........: 
  Talk & poster ..: 
  Tentative title :

If you have title and abstract ready please fill in the abstract form

PAYMENT

I pay the full registration fee of 30,000 Pesetas (~$US 210 or ~180 Euros) by:
....Cash, preferred, easier and relatively cheap
....Cheques (in Pesetas) payable to the Instituto de Astrofisica de Canarias.
....Credit cards: possible only by VISA or MASTER-CARD but not AMEX!
Please provide your credit card number and expire date:
Card number :
Expiredate :
....Bank transference to: (note that we might charge you the transference costs!)

Bank name:	Banco Bilbao Vizcaya
Bank address:	C/ Obispo Rey Redondo, 25
	E-38201 La Laguna, Tenerife
	Canary Islands, Spain
Full account number:	0182 0772 45 0000 134741

(Bank: 0182; Branch: 0772; Sorting code: 45; Account number: 0000 134741)

Please indicate the following with your bank transfer: "DPP, January 2000".

If you find any problem in filling this form, please contact the LOC by e-mail to planet@ll.iac.es

Last modified: Fri May 16 13:35:00 WET DST 1999