---------------- R E G I S T R A T I O N F O R M ---------------------- Mr/Mrs/Miss: ............................... First name: ................ Position: ................................ Company: ..................... Business address: ....................................................... Postcode: ........... Town: ...................... Country: ............. Phone: .................. Fax: ................... Email: ............... O Accompanying person Name: .................... First name: ......... A - Attendee Registration fees Before 15 March 1995: 2300 FF ...... After 15 March 1995: 2800 FF ...... Social program 24 May 1995: 150 FF ...... (guided tour) Proceedings Springer Verlag: 320 FF ...... TOTAL A ...... B - Accompanying person Gala dinner 24 May 1995 320 FF ...... Wine and cheese tasting 25 May 1995 150 FF ...... Social program 22, 23, 24 May 1995 330 FF per day ...... (22 May: Mont-Saint-Michel Bay 23 May: Between the earth and the ocean: The Fr'ehel Cape and Dinan 24 May: Discover Saint-Malo, the corsair city) TOTAL B ...... TOTAL AMOUNT (A + B) ...... PAYMENT PROCEDURE O I enclose a bank check drawn in French Francs, made out to CCETT-Eurocrypt'95 accompanied by my registration form O I am paying by bank transfer made to CCETT/ Banque de Bretagne/ Rennes Account Number 40168/00019/19241015619-58 Enclosed find a copy of the bank transfer bearing my name accompanied by my registration form All bank charges are at the expense of the registrant, not the beneficiary TRANSPORTATION I would like to receive SNCF discount coupon(s) in order to benefit from reductions on the French Railway Network O for myself O for ..... accompanying guests IACR MEMBERSHIP Payment of the registration fees entitles you to become a member of IACR Do you wish to be an IACR member? O Yes O No The form and the payment must be addressed to Francoise Scarabin, General Chair CCETT - Eurocrypt '95 4, rue du clos courtel F-35512 Cesson-Sevigne Cedex France Phone: +33.99.12.41.98 Fax: +33.99.12.40.98 email: iacr95@ccett.fr ------------------------------------------------------------------------- For any information about how to get an hotel registration form please contact: Virginia Cooper (secretariat Eurocrypt '95) Phone: +33.99.12.41.35 Fax: +33.99.12.40.98 email: iacr95@ccett.fr