REGISTRATION FEE FORM

Please type or print in BLOCK LETTERS and mail or fax to:

University of Tartu
14th Congress of the ISFNR
Ülikooli 16-208
51003 Tartu  
Estonia
Tel./ fax: +372 737 5310 

Please note that all amounts are payable in Euros only. 
All bank charges are assigned to the participant.

Registration fees:
	Until May 20th 2005 	From May 21st 2005 and on-site	
	Full registration	200 EUR	250 EUR	
Concessions*	150 EUR	180 EUR	

* accompanying persons, delegates from countries with non-convertible currencies, students, independent scholars, persons on benefits, retirees.

Personal information:
Familiy name: ______________________	First name(s): _______________
__ Mr.		__ Mrs.		__ Ms.		__ Prof.		__ Dr.
__ Student	__ Independent scholar	__ Retiree	__ Persons on benefits
Position: _________________________________
Institution: _________________________________________________________
Mailing address: _______________________________________________________
City: _____________________________________	Postal code: _______________
Country: __________________________________
Phone number: ____________________________	Cell phone number: _______________________
Fax number: ______________________________	E-Mail: _________________________________
Name(s) of accompaying person(s): _______________________________________

Name of the institution or person paying for the registration fee if other than indicated above:  _________________________________________________
Address of the institution or person paying for the registration fee:
_____________________________________________________________________
Type of payment:	__ Bank transfer		__ Credit card		

__ Bank transfer payable to EESTI ÜHISPANK
Please note that participant’s name and the abbreviation SFLKN must be mentioned in the “Details” field or appear elsewhere on the bank transfer.

Beneficiary’s bank details:
Beneficiary’s name: UNIVERSITY OF TARTU
Beneficiary’s address: Ülikooli 18, 51003 Tartu, Estonia
Name of the beneficiary’s bank: EESTI ÜHISPANK
Address of the beneficiary’s bank: Tornimäe 2, 15010 Tallinn, Estonia
Beneficiary’s bank account number (IBAN): EE281010102000234007
SWIFT code: EEUHEE2X

Charge to credit card	
Please note that a handling fee of 3 % applies for credit cards.	
__ VISA		__ MasterCard / Eurocard
Name of card holder: 						
Card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Credit card verification number*: __ __ __
	* The last three digit number printed on the signature panel located on the back of your card.
Expiry date: __ __ / __ __ (Month / Year)
Total amount (excluding handling fee of 3%): _______________ Euros

Date: ______________________
Signature:_______________________________________