Registration Form

Last Name:		
First name:		
Title:		
Affiliation:		
Department:		
Mailing Address:		
City:		
Post/Zip Code:		
State:		
Phone:		
Fax:		
Email:		
Name of accompanying person		

Workshop Fees:
Participants			Before March 31st, 2010		250 €		q
After March 31st, 2010		300 €		q
Students			Before March 31st, 2010		150 €		q
After March 31st, 2010		200 €		q
Accompanying Person	Before /After March 31st, 2010	 50 €		q

The fee will include access to the lectures, conference materials, coffee-breaks, Lunch and social events.

q Please check this box if you require special assistance to fully participate in this meeting. Briefly 
describe:_________________________________________________________________________

q  Please check this box if you want to participate in the social trip (cost € 15.00). The tour will be organised on Sunday, 16th May 2010. See the Workshop website for details. 

The workshop fee should be paid in Euro by bank transfer to the following account:
Name of account holder:		Universitätskasse Bochum
Account No.:  				1486828 
Name of Bank:			Sparkasse Bochum
Bank No.: 				430 500 01
IBAN:					DE 53 43050001 000 1486828
BIC-Code:				WELADED1BOC
Please, include the following note in the payment order: 
01 / 28211 / 7074845    and     the name(s) of the participant(s). 

Please send this form via email to: layeredmaterials@rub.de