++++++++++++++ Begin of GD'97 registration form ++++++++++++++++++++++ GD'97 Fifth Symposium on Graph Drawing Roma, Italy, September 18-20, 1997 Surname: __________________________ First name: _________________________ Affiliation: _____________________________________________________________ Mailing address: _________________________________________________________ _________________________________________________________________ ZIP, City: __________________________ Country: __________________________ Phone: ___________________________ Fax: __________________________________ Email: _______________________________________________ I want to pay the fee by money order [ ] to the following account: Bank name: Credito Emiliano Address: Via Rossini, 9 City: Rome Country: Italy ZIP Code: 00197 Account name: Mediamed Account number: 010001447 CAB Code: 03032 ABI Code: 03200 Phone: +39-6-8076274 or credit card [ ] VISA [ ] Mastercard NUMBER OF CREDIT CARD: _____________________________________________ EXPIRATION DATE: ___________________________________________________ SIGNATURE: _________________________________________________________ Registration Full [ ] 350,000 ITL Additional banquet tickets [ ] 90,000 ITL Total amount: ______________________________