Name (First M.I. Last): 

Department : 

Organization : 

Address : 

City :         

Postal Code :       

Country :  

Telephone :       FAX :  

E-Mail : 

Have you submitted an abstract ?       Yes         No

Do you plan to submit an Abstract ?     Yes      No

Tentative title of abstract (If Yes):

Are you a member of the Bernoulli Society ?     Yes      No

Are you a member of  TIES ?      Yes     No

Number of  persons in your party (including you) :

Number of  persons in your party
planning  to  join the excursion (including you) : 

Amount Deposited : 

Date of  Deposit (dd-mm-yy): 

Click on  {Submit}  in order to e-mail this form to esess@rc.aueb.gr