ESORICS 2004 REGISTRATION FORM To be returned to CWT / TRAVEL EXPO by fax to + 33 1 48 63 32 13 or mail to: esorics-raid2004@cwtfrance.com Participant (Please use one form per participant) : Last (Family) Name: ___________________ First (Given) Name: __________________ Title (Mrs, Mr, Prof, Dr): _______________ Affiliation : _________________________ Address: ________________________________________________________________ City: ________________________________ Zip code:___________________________ Country: _____________________________ E-mail: ____________________________ Phone: ______________________________ Fax:_______________________________ Registration Fee for ESORICS 2004: Registrations fees include admission to the technical sessions, proceedings, coffee breaks, lunches, evening reception, banquet, morning and evening shuttle between the venue and the hotels listed in the hotel registration form. All prices are given in Euro (€) Participant On or before July 20 after July 20 Regular 400 € 550 € Student 300 € 400 € Number of additional tickets (50 €) for the ESORICS Banquet - September 14 : _____ Please check if you need vegetarian meals [] Method of Payment: Payment must accompany registration form. - 1 - I duly authorize CWT/TRAVEL EXPO to charge my: VISA – MASTERCARD – AMERICAN EXPRESS (+2% charge): ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ Exp __ __ / __ __ for the amount of ___________ €. Signature of the owner: - 2 - Or by check to the order of C.S.V.T. Please state your name and the symposium reference (ESORICS 2004) on all transactions. REGULATIONS FOR ESORICS 2004 Cancellations and Substitutions Cancellations and substitutions are allowed. However, full registration fees will be charged unless a cancellation notice is sent in writing and postmarked on or before August 1, 2004 to CWT – TRAVEL EXPO Stéphanie BEAUSSART / ESORICS BP 60004 95970 ROISSY CDG Cedex - France A handling fee of 60 € will be applied to all canceled registrations. Please allow 10 weeks for processing. Substitutions can be made for all written requests received by the ESORICS 2004 Secretariat by August 31, 2004.   Disclaimer Neither the ESORICS 2004 chairs nor the ESORICS 2004 organizing committee can take any responsibility for any damage, loss or inconvenience participants might incur in connection with ESORICS 2004. They also cannot be held responsible for the correctness or appropriateness of the contents of talks and papers included in this conference. In particular, changes to the published program or cancellations of parts thereof do not entitle to a refund of the registration fee or parts thereof. Names and addresses of participants will be electronically processed and will be included in a list of participants that will be distributed during the conference except for participants who explicitly mentioned on the registration form that they do not want their name and address to be part of this list. By registering for the conference, participants express their agreements with these regulations. Registration will become effective only after receipt of your payment. Students Some fellowships to cover a part of registration fees are available. Students wishing to apply for fellowship should directly contact the Sponsorship Chair, Prof. M. Dacier, by e-mail (dacier@eurecom.fr). --------------------------------------------------------------------------------------- CWT / TRAVEL EXPO BP 60004 95970 ROISSY CDG Cedex Tel: + 33 1 48 63 30 48 Fax: + 33 1 48 63 32 13