Payment conditions

This form should be remitted only by ordinary (surface) mail to

Institut für Mathematik, Universität Klagenfurt z.H. Frau Christa Mitterfellner Universitätsstraße 65-67 A-9020 Klagenfurt, AUSTRIA

as follows:

Registered Person
	Last name: ________________________________________ First name: ________________________________________ Adress: ________________________________________ ________________________________________
Alternative 1:
Bank transfer of ___________ EURO (please enter the amount)
	free of any bank charges, should be made to:     ICTMT 5     Creditanstalt, Klagenfurt University Branch     Account number: 0881 43334 00     Bank identification code: 11000
Alternative 2:
Credit card
	Credit card: o Visa     o Master Card Credit card number: ____________________ Expiry date: ____________________ Card holder: ____________________ Amount to pay: ____________________ EURO Signature: ____________________