Mr. Mrs.

Title:

First Name: (*)

Last Name: (*)

School/Institution/Company:

Group (please fill out only if useful):

Street Address (or Postbox): (*)

Postal Code and City: (*)

State/Country: (*)

eMail: (*)

Phone (incl. country code):

Participation Fee: (*) Please indicate
Please note: Reduced participation fee (early booking) only available
until October 31, 2005.

EUR 100 Academics (Full 3 day participation, December, 14-16)

EUR 225/250 Others (Full 3 day participation, December, 14-16)
EUR 135/150 Others (Wednesday and Thursday, December, 14+15)
EUR 135/150 Others (Wednesday and Friday, December, 14+16)

Karlsruhe Students free (Evening receptions not included)

Included evening receptions: (*) Please indicate

I would like to participate in the following evening receptions:
Karlsruhe Castle (Wednesday)
ZKM (Thursday)

Please doublecheck your data before submitting this form!