Event Organizer |
Participant Data | |
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Compumag 2007 Secretariat
Institut of Electrical Machines Dr. Dirk van Riesen Schinkelstr. 4 52056 Aachen Germany Fax (national): 0241-8092270
Fax (international): +49-241-8092270
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user ID (on Compumag server, e.g. 123): .....................
Name: ................................................................... ............................................................................... Adress: ................................................................. ............................................................................... Country: ................................................................ |
| Payment Form for 'the 16th International Conference on the Computation of Electromagnetic Fields' |
| Qty. | Event / Product | Unit Price | Total Price | ||
| ............................................................. ............................................................. ............................................................. ............................................................. ............................................................. |
€ |
€ | |||
| Total | € | ||||
| Remark of Participant |
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| Payment Information | ||
Type of credit card: Visa Mastercard | Credit card holder: | |
Credit card number:
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Card validation code:
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Valid until: |
| Debit Agreement |
| I hereby authorize the organizers of 'Compumag 2007' to charge my credit card referenced above in the total amount of €................ |
Date/Signature: ________________ , _______________________________________ |