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             CONFERENCE ON COMPLEX ANALYSIS
on the occasion of professor JOZEF SICIAK 70th birthday
       Bielsko-Biala, Poland, 3-7 September 2001 
                  REGISTRATION FORM


(Please write in capital letters)


Family name _____________________________________________________


First name ______________________________________________________


Mailing address _________________________________________________


E-mail __________________________________________________________


Phone ___________________________________________________________


Fax _____________________________________________________________


Please charge my 

Eurocard / Mastercard / Visa / American Express 

(please circle) card for _________ U.S. dollars.


Card number ____________________________________________________


Expiry date ____________________________________________________



Signature _____________________________  Date _________________ 


After completing please mail this form to: 
  Malgorzata Downarowicz, Jagiellonian University, 
  Institute of Mathematics, Reymonta 4, 30-059 Krakow, Poland 
or fax it at: +48 12 6324372

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