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Ms. Mariann Kindl
CAO 2003 Conference Secretariat
MTA SZTAKI
H-1111 Budapest
Kende u. 13-17
Hungary
Fax: +36-1-386 9378
Personal Data |
Family name | Given name | ||
Phone |
Credit Card Data |
Card number | Expiry date | ||
Cardholder's name |
Cardholder's address |
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CVV code (last 3 digits of the security
code - see the back side of your card or on Amex Cards the
additional 4-digit code
on the front) |
Billing
address |
I allow the CAO 03 ( account no. 10032000-01738588) to charge my credit card of the amount
of HUF .......................
Date | ........................................................................... | Signature | ................................................................................ |