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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Email address (not for publication):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 bankRabobank
Account number
Account holder TU/e
De Rondom 70
5612 AP Eindhoven
IBAN nr NL42RABO0158249658
Mentioning 323120-1003616-Last_name

Comments (dietary restrictons, etc.):