AITO Support Application Number: ECOOP 2004/PHDOOS Workshop
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Mr/Mrs/Ms:
First Name:
Last Name:
Nationality:
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Private Address
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Street
No.
City
ZIP-Code
Country
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Affiliation
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Institution
Department
Street
No
City
ZIP-Code
Country
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Bank Account
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Bank name:
Bank Location/Address:
Bank account holder:
Bank account number:
In order to reduce the bank charges,
it is necessary to know the
Bank number (SWIFT-BIC-Code (Bank Identifier Code)
Usually, this is a number with 9 letters (including the country code) and 2 numbers.
A N D
IBAN (International Bank Account Number):
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Reason for attending ECOOP:
Reason for application for support:
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Type and amount of costs that are to be supported (all in Euro):
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Total of costs to be supported (in Euro)
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Original Documents have to be sent to
Walter Olthoff
AITO Treasurer
c/o DFKI GmbH
Erwin-Schroedinger-Strasse 57
67663 Kaiserslautern
Germany
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I understand that in case of a positive decision I will present AITO a proper documentation of the cost, i.e. bills and receipts to prove that I had the claimed expenditures.
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Signature of applicant:
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