"SPEED-B" Registration form

Registration form

First name and middle initials:

Last name:

Affiliation (the text you want to have appear on your nametag along with your name):

The information above will be used for name tags.

Email address (not for publication):

I confirm that this is my email address, and I agree to receive email at this address about this event.

The late registration fee for the SPEED-B Workshop is 170 EUR, covering all talks, dinner on the 20th, lunches on 19th, 20th, and 21st, and 4 coffee breaks.
Payment can only be done by electronic bank transfer. Please make the bank transfer as soon as possible.

Name bank	Rabobank
Account number	15.82.49.658
Account holder	TU/e
	De Rondom 70
	5612 AP Eindhoven
BIC Code	RABONL2U
IBAN nr	NL42RABO0158249658
Mentioning	323120-1003616-Last_name

For bank transfers from countries using the Euro, please mark the transfer as shared cost "SHA" (this is free for both sides).
For bank transfers from countries not using the Euro, please mark the transfer as sender's cost "OUR" (this makes sure that we receive exactly 170 EUR; you need to cover the transaction fees if any).

Comments (dietary restrictons, etc.):