International Conference on Logic Programming
                                    ICLP'99
                   ---------------------------------------------

                                REGISTRATION FORM

Please return this form either via:
- e-mail: iclp99@cs.nmsu.edu
- fax: Attn: Gopal Gupta (ICLP'99)
             +1 - 505 - 646 - 1002
- standard mail: 
         Gopal Gupta (ICLP'99)
         Dept. Computer Science
         New Mexico State University
         Box 30001/CS
         Las Cruces, NM 88003, USA
with completed payment information.

Last Name    : 
First Name   : 
Title        : 
Affiliation  : 
Address      : 
City         : 
Zip          : 
Country      : 
Telephone    : 
Fax          : 
e-mail       : 

ALP Member   : Yes / No
Student      : Yes / No

Date         :


         ICLP Conference fee    :
         NLULP fee              :
         Reduced ICLP/LPNMR fee :
         Workshop only          :
                                ---------------
         Subtotal               :               U.S. Dollars
         (4% for CC payment)    :
                                ---------------
         TOTAL                  :               U.S. Dollars

Payment Method:

o      Credit Card:
 
       Type:           Visa ( )  Mastercard ( )
       Card number:
       Expiration date:
       Name as on the card:
       Amount:           U.S. Dollars
       Authorized Signature:

       Note: a 4% processing fee should be added for 
             credit card payments

o      Electronic Bank Transfer

       Prof./Dr./Mr./Ms. : 
       has remitted the total of  ....... U.S. Dollars

       through (bank name) ...........................

       to this account:
           Account Name:     ICLP99
           Account Number:   1350255509
           Routing Number:   107002192
           Name of Bank:     Norwest Bank
                             1701 University Avenue
                             Las Cruces, NM 88001, USA
      Please make sure that ALL bank charges are at the participant's 
      expense.

o     Banker Draft/Money Order/Bank Check:
      
      A (select one)
                     -   Bankers Draft
                     -   Money Order
                     -   Bank Check
     
      amounting to ......... U.S. Dollars is enclosed.
      Please make checks payable to ICLP99. Please make sure that the
      bank charges are at the participant's expense.