Optimal design course Please complete this form and press the submit button at the bottom. You will receive a confirmation of your registration per email. Personal information Title: Mrs. Mr. First Name: (*)   Last Name: (*)   Email Address: (*)     Affiliation: (*)   Department: Street: (*)   Zip/Postal: (*)   City: (*)   Country: (*)   Phone Number: (*)   Fax Number: Registration Fee (*)  Academic: 150 euro Staff Universiteit Antwerpen: 50 euro Other: 750 euro Conference dinner Would you like vegetarian meals? yes no  Remarks/special requests