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From Icon to Art in the
Netherlands
Baltimore/Washington, November
8-12, 2006
PRINT THIS FORM
American members may
pay by check, made out to
HNA-Conference, or by credit
card. Payment and registration
form should be sent before
September 1, to Quint Gregory,
Department of Art History and
Archaeology, 1211B Art/Sociology
Building, University of Maryland,
College Park MD 20742
European members may
pay by credit card or may
transfer funds directly to the
HNA account at the Postbank
Berlin.
From Germany: a/c no. 0744
146 108, bank no. 100 100 10
From other European Countries:
IBAN DE88 10010010 0744 1461 08
and BIC PBNKDEFF
Mark your payment "HNA Conference" and send your registration form to Quint Gregory and not the European Treasurer.
Please note: Confirmation will
not be sent in advance of the
conference
Name
______________________________
Affiliation
___________________________
Address
_____________________________
_____________________________
_____________________________
Tel ____________________
E-mail
______________________________
Please circle appropriate places
Members _______________ $
120/euros 96
Non-members ___________ $
140/euros 112
Students ________________ $ 60/euros 48
(with proof of student
status)
Optional
Banquet (Friday, Nov.
10) __ $
46/euros 37
Diptychs exhibition, NG
Washington (Sat. Nov. 11)
Bus to
Washington ________ $
20/euros 16
Boxed lunch _____________ $
7/euros 6
TOTAL
__________________
MasterCard or Visa
MasterCard
Visa
Card#:
_____________________________
Expiration date:
_____________________
Signature:
___________________________
If your card carries a three-
or four-digit code (usually found
on the back), please include this
number
Print and send before September 1,
2006, to: Quint Gregory,
Department of Art History and
Archaeology, 1211B Art/Sociology
Building, University of Maryland,
College Park MD 20742
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