REGISTRATION FORM



Family name: _________________________________   Mr.      O     Mrs.    O

First Name: _____________________________        Initials: ______________

Title/Function: Prof. ( ) Dr. ( ) Engineer ( ) Ph.D./MSc.student ( ), Other ( )

Organisation: ___________________________________________________________

Department: _____________________________________________________________

Address: ________________________________________________________________

Postal Code: _________________________  City: ___________________________

State/Province: ______________________  Country: ________________________

Tel.: + _____________________________    Fax: + _________________________

Email: __________________________________________________________________


Hotel accommodation needed? Yes/No
If yes, please indicate the period and the choice of the hotel. 
From March ..., 2004 to March ..., 2004, 
hotel choice _______, room (Single/Double):________.

1. Hotel Leeuwenburg *** (http://www.leeuwenbrug.nl/) 
   Single room: 67.50 euros per night; Double room: 82 euros per night.  
   (incl. breakfast, excl. tourisme tax of 2 euros)
   It is approx. 10 minutes from station Delft, and at 20 minutes walking 
   distance to the Mekelweg 4 (workshop venue).

2. Dutch hotel Hotel *** (http://www.dutchhoteldelft.nl/)
   Single room: 94 euros per night; Double room: 109 euros per night.  
   (incl. breakfastand tourisme tax)
   It is approx. 15 minutes from station Delft, and at 10 minutes walking
   distance to the Mekelweg 4 (workshop venue).


I will be accompanied by the following person(s); when children mention
their age

Mrs./Mr.:________________________________________________________________


P.S. a limited number of hotel rooms is available (double room, shared 
with another participant), you can ask the organisers about the 
availablitiy by email. 

Workshop receptions and dinner
(the workshop, receptions and dinner are free of charge) 
O Reception at March 15 (evening)             Yes/No
O Reception at March 16 (evening)             Yes/No
O Reception at March 17 (evening)             Yes/No
O Dinner at March 18 (evening)                Yes/No




Signature:___________________                 Date:______________________







This form should be faxed or e-mailed to as soon as possible:


Organizers SWI 2004 

Faculty of Electronics, Mathematics and Informatics

Mekelweg 4, 2628 CD Delft, The Netherlands

Fax: + 31 15 2787245 or 2787295 

E-mail: swi@ewi.tudelft.nl
REGISTRATION FORM

Workshop receptions and dinner (the workshop, receptions and dinner are free of charge)
