PARTICIPANT REGISTRATION FORM

18TH INTERNATIONAL CONFERENCE ON RELIABLE SOFTWARE TECHNOLOGIES – ADA-EUROPE 2013, 10-14 JUNE 2013, BERLIN, GERMANY

Participant Ms [ ] Mr [ ] Title: ____________

First name: Last name:

Affiliation/Organization:

Address:

Zip/Postal code: City:

Country:

Phone: Fax: Email:

Special requirements (e.g. diet):                                        ___________

Permission
to release personal data for conference purposes (participants list etc.)

Name, Institution, Town, Email                    Yes [ ]                      No [ ]

Please indicate whether you agree to receive information about other related conferences by the organizing institutions:  Yes [ ]                                                      No [ ]

Membership

Reduced registration fee

[ ]  Member Ada-Europe, ACM SIG (Ada, BED, PLAN), Ada Germany
     Please mention the membership organisation: ________________________

[ ]  Academia, Institution: ____________________________________________

[ ]  VIPs (use only by instruction of the conference organizers) ______________

Membership number (if any): ________________________________

Additional Comments: _____________________________________

Registration Type

Early (until April, 30th)                          [ ]

Late or on site (after April,30th)           [ ]

Registration Fees (see table on previous page or web site)

Conference registration fee

Three days registration:                                  ____________ EUR
Individual days (Tue [ ]  Wed [ ] Thu [ ]):     ____________ EUR

Tutorial registration
(please indicate the tutorials for which you want to register):

Monday, 10 June, morning      T1 [ ]         T2 [ ]         T3 [ ]

Monday, 10 June, afternoon    T4 [ ]         T5 [ ]         T6 [ ]

Friday, 14 June, morning         T7 [ ]         T8 [ ]         T9 [ ]

Friday, 14 June, afternoon       T7           T10 [ ]       T11 [ ]

Tutorial registration fee:                                  ___________ EUR
Without conference registration add 30,00 EUR for Tutorial registration

Working Groups (members only)

ISO WG23              (Saturday, 8.6. – Monday, 10.6.) 195 Euro

ISO WG9                 (Friday, 14.6.)                                   0 Euro

ISO WG9/ARG       (Friday, 14.6. – Sunday, 16.6.)     185 EUR

WG registration fee:                                        ___________ EUR
Without conference registration add 30,00 EUR for WG registration

Extra packages

Extra tickets for banquet (@ 120 EUR each):    ________ EUR
Extra proceedings (@ 30 EUR each):                 ________ EUR

Accommodation at Seminaris Hotel

Arrival Date: _____________ Departure Date: _____________

Single              [ ] Double Occupancy                  [ ]

Name of accompanying person:
First Name ____________ Last Name __________________

Extra tickets for lunches and dinners may be obtained at the conference registration desk.

Dietary Restrictions: ________________________________

Special Requests: __________________________________

Accommodation total cost: _____________ EUR

Total Payment Due _________________ EUR

Payment method

[ ] By credit card Visa [ ] Mastercard [ ] Diners [ ]

Card Number:___________________ Expiry date: _________

Cardholder Name:_______________ CVC ⁽¹⁾:_____________

Signature:______________________ Date: ______________

I hereby authorize my account to be debited directly for the sum of: ___________________________€

If payment is made by credit card, please send a printed registration with your credit card account separately by Fax to 0049 2641 90 35 80.

(1) The Card Validation Code is the final 3 digits of the number printed in the signature strip on the reverse of your card.

[ ] By bank transfer⁽²⁾, to account number (IBAN)

International Bank details:

Account Name: Christine Harms, Bank Name: Volksbank RheinAhrEifel eG.,

Address: Hauptstr. 119, 53474 Bad Neuenahr-Ahrweiler, Germany,

BIC: GENODED1BNA, IBAN: DE 07 5776 1591 0399 4063 00

Please mention your name, your company and „AE2013“ and in case of an invoice its number.

(2) Please make checks or bank transfers in Euro. Payments in other currencies will not be accepted.