EUROCRYPT '97 Registration Form Registration Deadline: April 1st, 1997 Last Name: _______________________________________________ First Name: ______________________________________________ Affiliation: _____________________________________________ Mailing Address: ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ Phone: ________________________ Fax: _________________________ Electronic Mail: ________________________________________________ URL: ____________________________________________________________ If you wish to have your name and address EXCLUDED from the list of delegates and the published I.A.C.R. membership list check here: ______ Payment of the conference fee entitles you to FREE membership in the International Association for Cryptologic Research for 1998 at no extra charge, including a FREE subscription to the Journal of Cryptology, published by Springer-Verlag. If you do NOT wish to be an I.A.C.R. member and do NOT wish to receive the journal check here: _____ Conference Registration Fee (check first box which applies): Paid by Paid after April 1st, 1997 April 1st, 1997 _____ Full-Time Student DM 365, -- DM 415, -- _____ Regular Registration DM 730, -- DM 780 ,-- DM _____ Companion Program (Excursion): ____ Konstanz Tour de Ville DM 20, - DM _____ ____ Stadt Meersburg DM 40, - DM _____ ____ Schloss Arenenberg DM 40, - DM _____ ____ Tuesday Conference Excursion DM 30, - DM _____ (visit to island of Mainau) ____ Wednesday Conference Dinner DM 50,- DM _____ (on board the MS Graf Zeppelin) TOTAL ENCLOSED OR PAID BY CREDIT CARD DM ______ Payments must be either by bank transfer to Postbank Saarbrucken, BLZ 590 100 66, Account No. 166081-669, Order No. 476 002 47 (important !) or by credit card. Credit Card payment must be mailed or faxed to the number below. Check one ____ VISA ____ MasterCard Name on card: __________________________________________ Card number: ___________________________________________ Cardholder signature: __________________________________ Expiration date: _______________________________________ For room reservations please use the enclosed Hotel Reservation Card, also available at http://www.iacr.org/conferences/ec97/hotel.htm Forms and enclosed payments must be sent to: Alfred Bullesbach, EUROCRYPT '97 debis Systemhaus GmbH; Data Protection and IT-Security Fasanenweg 9; D - 70771 Leinfelden-Echterdingen GERMANY For more information: Email: eurocrypt97@iacr.org WWW: http://www.iacr.org Phone: + 49 711 972 2584 Fax: + 49 711 972 1918