JUNE 28-30, 2001 Villa Olmo Quantum Computers and Quantum Chaos

Registration Fee

(PLEASE TYPE OR WRITE IN BLOCK LETTERS - ONLY ONE FORM PER PARTICIPANT)

to be sent to Chiara Stefanetti (fax +39.031.573395 - email: stefanetti@icil64.cilea.it)

FAMILY NAME ...................................................................................................................................................

FIRST NAME ......................................................................................................................................................

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I will be accompanied by

FAMILY NAME ...................................................................................................................................................

FIRST NAME ......................................................................................................................................................

Registration fees: Regular Participant 100 Euro

Student Participant 50 Euro I will pay by:

? EUROCHEQUE to be addressed and sent to Centro ?A. Volta"

Villa Olmo, Via Cantoni 1, I-22100 Como (Italy)

? BANK TRANSFER

On Cariplo (sede di Como, Via Rubini 6, 22100 Como)

Account n.: 21407/1 holder: Centro ?A. Volta"

Abi code: 06070 Cab code: 10900 - please make a reference to ?Quantum"

? CREDIT CARD:  VISA  Mastercard  Eurocard

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TYPE OF CARD ............................................................................................................

NAME AND ADDRESS OF CREDIT CARD HOLDER .................................................

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I would like to have:  receipt (to be picked up during the conference)  invoice

Invoice to be sent to: ?????????????????????????????

???????????????????????????????????????.

VAT identification number (necessary for invoice)????????????????

DATE, SIGNATURE .......................................................................................