Eurocomb 2017 European Conference on Combinatorics, Graph Theory and Applications Vienna, August 28 - September 1, 2017 Payment Authorization Name: _____________________________________________________________________ email: _____________________________________________________________________ Institution (name/address): ____________________________________________________ Credit card holder (if different): _________________________________________________ Credit card holder´s (private) address: ______________________________________________ Credit card company: Visa/Mastercard/AMEX Credit card number: __________________________________________________________ Expiration date (month/year): ___________________ CVC: _______________________ For the participation in the „European Conference on Combinatorics, Graph Theory and Applications“ (Eurocomb 2017), please charge the amount of ____________€ against my credit card. Date: ________________________ Signature: ________________________________________ Please forward your authorization per email or fax to: Sonja Rees, Institute of Discrete Mathematics and Geometry Vienna University of Technology [email protected], fax +43-1-58801-10499
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