SBAC-PAD'2001 September 10-12th, 2001 Pirenopolis, GO, Brazil Pousada dos Pireneus Resort ----------------------------------------------------- Registration Form ----------------------------------------------------- Title: (_) Mr. (_) Mrs. Last name: __________________________________________ Middle name: ________________________________________ First name: _________________________________________ Author: (_) Yes (_) No Passport number/CPF: ________________________________ Institution/Company/Organization: ___________________ Address: ____________________________________________ ____________________________________________ City: _______________________________________________ State: ______________________________________________ ZIP Code: ___________________________________________ Country: ____________________________________________ Phone number: _______________________________________ Fax number: _________________________________________ E-mail: _____________________________________________ ----------------------------------------------------- Choose the registration option: Early Registration: Until August 8th, 2001 (_) SBC/IFIP member: US$ 200,00 (_) Non member: US$ 240,00 (_) SBC Student member: US$ 100,00 (_) Student non member: US$ 120,00 (_) SPECIAL FEE(*) US$ 50,00 Regular Registration: After August 8th, 2001 (_) SBC/IFIP member: US$ 240,00 (_) Non member: US$ 280,00 (_) SBC Student member: US$ 140,00 (_) Student non member: US$ 160,00 (_) SPECIAL FEE(*) US$ 70,00 Membership: (_) SBC member (Number: __________________________) (_) IFIP member (Number: _________________________) Indicate the number of tickets or extra proceedings: (_) Early: Until August 8th, 2001 _____ Conference Dinner US$ 10,00 _____ Extra Proceedings US$ 20,00 (_) Regular: After August 8th, 2001 _____ Conference Dinner US$ 15,00 _____ Extra Proceedings US$ 30,00 Please fill out the total fee: (_) US$ ___________________ Note: For payments within Brazil (using Reais), use SBAC's exchange rates by sending an e-mail message to mario@cic.unb.br and/or rosa@cic.unb.br. (*) Special fee includes only the attendence to the event sessions, and is limited and offered only to undergraduate students who provide a valid student ID. ----------------------------------------------------- Payment (choose an option): (_) Check or deposit on Banco do Brasil, payable to SOCIEDADE BRASILEIRA DE COMPUTACAO - SBAC-PAD'2001 Bank number: 001 Agency number: 3603-X Account number: 15.368-0 (_) Credit Card (only VISA) Name: __________________________________________ (Exactly as in the credit card) Credit card number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Expiration date: ___/___ Signature: ____________________________________ ----------------------------------------------------- Mail or fax the registration form to: SBAC-PAD'2001 Secretary Campus Universitario - Asa Norte - ICC Ala Norte - Sub-solo, Caixa Postal 4466 70.910-900 - Brasilia, DF, Brazil Fax: +55 (61) 273-2131