LUATCS '99

REGISTRATION FORM

Wherever requested to indicate choices, please mark with an X in the brackets or leave blank. The completed registration form should reach us by SEPTEMBER 1 per e-mail, fax, or ordinary mail.

1. PERSONAL INFORMATION

Title, surname, and first name(s): .............................................................................
Affiliation: ...............................................................................................................
Address: ................................................................................................................
...............................................................................................................................
Telephone: .............................
Fax:........................................
E-mail address:.....................................................................

Student[ ]   Academic[ ]   Other[ ]   (Please choose one of these.)

Accompanying persons: Yes[ ] / No[ ]

If yes, Name(s): .....................................................

2. DETAILS ON PARTICIPATION
2.i) Which parts of the school would you like to attend?

Part 1 [ ]   Part 2 [ ]   Both parts [ ]

2.ii) Which courses and tutorials/workshops do you intend to attend?
(This is just preliminary info for us. You can change your mind later.)

Part 1 (1-4 Dec):
Blackburn[ ] Gumm[ ] Melton[ ] Schlingloff[ ] Valeriote[ ] Venema[ ]

Part 2 (6-10 Dec):
Chaochen[ ] Davey[ ] Dawar[ ] de Rijke[ ] Farley[ ] Gehrke[ ] Hirsch[ ] Hodges[ ] Jacobs/Rutten[ ] Jech[ ] van Benthem[ ] Vardi[ ] Zucker[ ]

2.iii) Which sets of course notes/readers do you want to receive? (The cost of 6 sets per part is included in the registration fee; the rest will cost up to R20 per set - payable on arrival.)

Part 1 (1-4 Dec):
Blackburn[ ] Gumm[ ] Melton[ ] Schlingloff[ ] Valeriote[ ] Venema[ ]

Part 2 (6-10 Dec):
Chaochen[ ] Davey[ ] Dawar[ ] de Rijke[ ] Farley[ ] Gehrke[ ] Hirsch[ ] Hodges[ ] Jacobs/Rutten[ ] Jech[ ] van Benthem[ ] Vardi[ ] Zucker[ ]

2.iv) Do you intend to give a talk in a workshop or an open session?

Workshop[ ] / Open session[ ] / None [ ]

If yes, please give a title and specify the workshop (if applicable):......................................
........................................................................................................................................

3. TRAVEL
3.i) Arrival date and time, airline and flight number (if already known): .........................
........................................................................................................
3.ii) Departure date and time: ..........................................................
Do you need transportation from and to Johannesburg bus station or airport? Station[ ] / Airport[ ]

4. ACCOMMODATION (If you have accompanying persons, please book for them, too.)
4.i) Part 1: December 1-4. Arrival and registration day: Nov 30. Departure : Dec 5.
RAU Island: total package of R550 per person, including accommodation, 3 meals a day, refreshments, and bus/boat transport to and from the island.

4.ii) Part 2: Dec 6-10, RAU Campus. Arrival and registration day: Dec 5. Departure: evening of Dec 10, or later; for the hostels: not later than Dec 11 unless arranged individually.

Please indicate your preferences for accommodation in a priority order, choosing from the options below. All prices are per room per night, for single rooms including breakfast, for double rooms excluding breakfast (@ R29 per person).

1. ............................................
2. ............................................
3. ............................................

If sharing a double room in the hotel, the name of your roommate:
Note that a R200 accommodation deposit is required, payable with registration fee.

A) Hotel: R244 (single, incl. breakfast), R230 (double per room, excl. breakfast)

B1) Guest-house at R200 - R250.
B2) Guest-house at R250 - R300.

C) Student hostel: R100.

D) My own arrangement.

5. VARIA.
If you have accompanying persons, please book for them as well, by putting a number in the brackets. All payments are due on arrival.

5.i) Would you like lunch package(s) during Dec 6-10 (@ R150 per package)? Yes [ ] No[ ]. Please specify any dietary restrictions:

5.ii) Would you like to attend the banquet on Dec 8 (@ R70 per person)? Yes [ ] No [ ].

5.iii) Would you like to join the outing on Saturday, Dec 11 (@ approx. R50)?

• to Gold Reef City, Johannesburg [ ]
• to the Rhino and Lion Nature Reserve and Sterkfontein Caves [ ].

6. PAYMENTS.
6.i) Please indicate the registration fee applicable to you (IF PAYABLE AFTER SEPTEMBER 1, PLEASE ADD 20% TO THE RATES BELOW) here: [.........]

(*Please attach proof.)

TOTAL PAYMENT DUE: (Deposit and registration fee) [.........]

6ii) Means of payment

A) Personal or bank cheque PAYABLE IN SOUTH AFRICAN RANDS, made out to: RAU LUATCS '99. Send to: LUATCS'99, Department of Mathematics, PO Box 524, Auckland Park 2006, SOUTH AFRICA.

Cheque enclosed : Yes[ ] / Will be sent later [ ].

B) Please debit my credit card:
Card type: Visa[ ] Master[ ] Euro[ ] American Express[ ] Diners Club [ ]
Card number :
Expiry date :
Name as it appears on the card:
Authorization for total amount:

C) Bank Transfer To: ABSA Bank, Auckland Park, Branch number 33510524,
Account number : 284 0000 136.

PLEASE NOTE: if you use bank transfer, your surname and initials as well as this reference number: 9331 8659 05 must appear on the deposit slip, of which a copy must be sent to us.

7) REMARKS (if any):

SIGNATURE : ................................................. DATE : .................