Return to: Günter Küppers
IWT (Institute for Science and Technology Studies)
University of Bielefeld, Post Box 100 131, D-33501 Bielefeld
Fax: Nr.:+521/1065844
e-mail :guenter.kueppers@uni-bielefeld.de

EASST - 4 S Joint Conference

Bielefeld, Oct. 10-13, 1996

Registration Information

Surname:____________ Name:___________ Title:_______________,

Address:__________________________________________________ _________________________________________________________

Country:______________ Phone:_____________ Fax:____________ email:___________

Position:___________________

Registration

__Member of EASST or 4S DM 140 (after June 30. 1996 DM 200)

__Non-member of EASST or 4S DM 200 (after June 30. 1996 DM 260)

__Student DM 80 (after June 30. 1996 DM 100)

__Banquet Friday evening DM 50

The total fee of DM ________ will be paid by:

__Master/Eurocard
__VISA
__American Express

Credit card number: _____________________________________________________
Expiration date: ________________________________________________________
Name: ________________________________________________________________

__ by sending bank account to:
Gunter Kuppers, Sparkasse Bielefeld, No. 43 00 65 43, BLZ 480 501 61

Date/Signature:______________________,____________________________________