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\def\koutaki{$\Box$}
\def\koutara{{ \Huge \raise-0.5ex\hbox{$\Box$}}}

\def\degr{\hbox{$^\circ$}}

\begin{document}
\vspace*{-1cm}
\begin{center}
{\bf Joint European and National Astronomical Meeting for 1997\\
{\Large \bf JENAM - 97}\\
2 -- 5 July 1997}

{\Large \bf R E G I S T R A T I O N \ \ F O R M \footnote{Please complete the 
                                        {\sc Payment Form} as well.}}
\end{center}
\vspace{0.1cm}
\begin{center}
\hrule
\begin{tabular}{p{11cm}}
Submit this form by normal post or fax to the {\bf Contact address}
of the Local Organising Committee, mentioned in \S 3.\\
\multicolumn{1}{c}{\bf Deadline for early registration: March 15, 1997}\\[0.1cm]
\multicolumn{1}{c}{Direct questions to: {\bf elaset@astro.auth.gr}}
\end{tabular}
\end{center}
\hrule
You will receive a confirmation from the LOC as soon as your registration 
has been processed.\\

\vspace*{0.1cm}
Family Name:\ \hrulefill\ First name:\ \hrulefill\ Initials:\ \hrulefill\\
Title:\ \hfill Professor \koutaki \hfill Dr. \koutaki \hfill Mr. \koutaki 
        \hfill Mrs. \koutaki \hfill Miss \koutaki \hfill Ph.D. Student \koutaki \\
Affiliation for {\it Name Badge}:\ \hrulefill\\ 

E-mail:\ \hrulefill\\
Phone number:\ \hrulefill\ Fax number:\ \hrulefill\\

Institution:\ \hrulefill\\
Postal address:\ \hrulefill\\
\phantom{Postal address:} \hrulefill\\
\phantom{Postal address:} City:\ \hrulefill\ Zip Code:\ \hrulefill\ Country:\ \hrulefill\\

Accompanying person(s):\ \hrulefill\\
\phantom{Accompanying person(s):} \hrulefill\\[0.6cm]
{\small
\begin{tabular}{|ll|cc|cc|}
\hline
  & No. of  & \multicolumn{2}{|c|}{\bf Early Registration} 
                  & \multicolumn{2}{|c|}{\bf Late Registration} \\
  & persons & \multicolumn{2}{|c|}{\small\bf (until March 15, 1997)}
                  & \multicolumn{2}{|c|}{\small\bf (after March 15, 1997)} \\
         &        & (US\$) & (GDr) & (US\$) & (GDr) \\
\hline
 & & & & & \\
General registration & $\times $ \koutara & 
. . . . . . . & . . . . . . & . . . . . . . & . . . . . . . \\
E.A.S. Ordinary Member  & $\times $ \koutara & 
. . . . . . . & . . . . . . & . . . . . . . & . . . . . . . \\
E.A.S. Junior Member    & $\times $ \koutara & 
. . . . . . . & . . . . . . & . . . . . . . & . . . . . . . \\
Hel.A.S. Ordinary Member & $\times $ \koutara & 
. . . . . . . & . . . . . . & . . . . . . . & . . . . . . . \\
Hel.A.S. Junior Member & $\times $ \koutara & 
. . . . . . . & . . . . . . & . . . . . . . & . . . . . . . \\
Accompanying Person  & $\times $ \koutara & 
. . . . . . . & . . . . . . & . . . . . . . & . . . . . . . \\
 & & & & & \\
\hline
   & \multicolumn{1}{r|}{Total amount}&
. . . . . . . & . . . . . . & . . . . . . . & . . . . . . . \\
\hline
\end{tabular}}

\vspace*{0.4cm}

Will you be presenting a paper? (YES\footnote{Please complete the 
   {\sc Paper Contribution Form}}/NO) . . . . .
   
\vspace*{1cm}
\hspace*{9.7cm} Signature: . . . . . . . . . . . . . . . \\

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\end{document}

