SLCS-10 Registration Form
10th International Conference
 of Shallow Level Centers
 in Semiconductors
Warsaw, Poland, 24-27 July 2002	Please complete this form using CAPITAL LETTERS and send to:
Dr. Ryszard Buczko, Institute of Physics PAS
Al. Lotników 32/46, 02-668 Warsaw, Poland
or to fax (+48 22) 843 09 26,        or to e-mail: slcs-10@fuw.edu.pl	

Title: 		Prof. 		Dr.		 Mr. 		Mrs. 		Ms.	
............................................................................................…………………………….
First name	Middle Initial	Last Name
Affiliation   ..........................................................................……………………………….................................…………..
(Dept. Univ. or Company)
Mailing address:      ......................................................................……………………………................……….
Street
................................................................................................................……………………….................………
Country 	Postal Code	 City
Tel.:
 (include country and area code)	Fax:
 (include country and area code)	e-mail:	

Accompanying person
Mr./Mrs./Ms.   ……………………………………………………………............................................……
First name	Middle Initial	Last Name
		Payment	
Registration fee (before 30 May 2002)	220 USD / 250 EUR		
Late registration (after 30 May 2002)	300 USD / 340 EUR		
Registration fee 
for Accompanying person	50 USD / 55 EUR
(Reception and diner)		
Student registration fee	140 USD / 160 EUR		
Total			
Students should include copy of Student ID Card or letter of confirmation.
Total amount will be paid as follows:
	By Bank transfer to:	Warsaw University
BIG BG S.A.
I/O Warszawa
account number:11601029-30506087  
account number:11601029-30506007	
			
	(for USD use)  
(for EUR use)  		
	For non US banks only: 	Swift code BIGBPLPW	
Please indicate on the transfer “SLCS-10”.
Please note that the bank account for registration fee is DIFFERENT from that for hotel payment. 
All bank charges must be paid by the participant. 
If the remitter’s name differs from the participant’s name, please state clearly the name of the participant.

OR
By credit card:		Visa		Eurocard / Mastercard	

When the registration fee payment is made by credit card, the form should be sent by post or fax (not e-mail).   

Card number:																	
………………………………………………..	……………………..
Cardholder Name	Expiration Date
………………………………	………………………………
Date	Signature

NO CHEQUES WILL BE ACCEPTED