14th INTERNATIONAL CONGRESS ON CYBERNETICS

Namur, 21st-25th August 1995

IDENTITY AND REGISTRATION FORM

This form is to be sent to :

International Association for Cybernetics,

Palais des Expositions, avenue Sergent Vrithoff, 2

B-5000 Namur, Belgium.

Name : ............................................................. First Name : ...................................

Titles, Position, Function : ............................................................................................

.........................................................................................................................................

Company or Institution : ..............................................................................................

.........................................................................................................................................

Postal Address (Street, City, Country, Post Code) : ....................................................

.........................................................................................................................................

.........................................................................................................................................

Nationality : .................................................................................................................

I plan to attend the Congress : Yes - No

Registration fee :

- members of the Association and authors of papers : 9000 BEF/360 $

- other participants : 12000 BEF/480 $

- young researchers (under 30 years) : 5000 BEF/200 $

Lunches :

21 august , 22 august , 23 august , 24 august , 25 august

thus ........ x 330 BEF/14 $ = .................. BEF/ .................... $

Proceedings :

The pre-August 25, 1995 subscription price : 6000 BEF/240 $

Enclosed a cheque for : ...................................

Date Signature