International Conference on Logic Programming (ICLP'99)

                                   November 29 - December 4, 1999
                           New Mexico State University, Las Cruces, New Mexico


Accommodation Form

 Last name 
                  : Momigliano
                   
 First name 
                  : Alberto
                   
 Title
                  : PhD
                   
 E-mail address
                  :mobile@cs.cmu.edu
                   
 Street 
                  : 358 S. Atlantic Ave,
                   
 City 
                  :Pittsburgh
                   
 Postal code      : 15224

 Country 

                 :USA
			
 Tel. 
                  :412 441 8239


I would like to reserve a room at: Sleep Inn
to attend ICLP'99 at New Mexico State University 

 Arrival date : November 28th 1998
 Departure date : December 4th
 Nr. of nights : 6

  
 Single room [X ]


 Nonsmoking [X ] 
                   

Payment

   Number of Credit Card : MC  5442 2080 4296 9645
   Expiry date : 01/03
   Name of the Cardholder : Alberto Momigliano

   Signature : ......................................

  Date : .........................................