\documentclass[12pt]{article}
\pagestyle{empty}

\textheight24.5cm

\textwidth17cm
\hoffset -1.5cm
\begin{document}



\centerline{\bf SUMMER SCHOOL on DIFFERENTIAL GEOMETRY}

\vspace {0.75 cm}
\centerline{\bf 3/7 September 1999}

\vspace {1 cm}

\centerline{\sc Registration}

\vspace {0.5 cm}


\begin{itemize}
\item [] {\bf Name}\hrulefill

\hrulefill

\item [] {\bf Af\/f\/iliation}\hrulefill

\hrulefill

\item[] {\bf Contact Address}\hrulefill

\hrulefill

\item[] {\bf e-Mail}\hrulefill {\bf Phone}\hrulefill

\vspace {0.75 cm}

I would like to attend the course

\vspace {0.5 cm}
\begin{itemize}
\item [] {\bf  Geometry of
Submanifolds}
\raisebox{0.65ex}{\fbox{\rule{0 cm} {0.25 cm} }}
\item [] {\bf Poisson and
Symplectic Geometry}  \raisebox{0.65ex}{\fbox{\rule{0 cm} {0.25 cm} }}
\end{itemize}
\vspace {0.75 cm}

I would like to contribute a 20 minute talk  ({\bf subject to acceptance
by the Organizing Committee} - a few contributions can still
be accepted)  \raisebox{0.65ex}{\fbox{\rule{0 cm} {0.25 cm} }}

\begin{itemize}
\item [] {\bf Title}\hrulefill

\hrulefill
\end{itemize}

\vspace{0.75 cm}

I would like to apply for a scholarship and enclose my C.V.
(a few
scholarships are still available)
\raisebox{0.65ex}{\fbox{\rule{0 cm} {0.25 cm} }}

\end{itemize}

\vspace {0.75 cm}

Please fill in and return by 15 May 1999
to

\bigskip

F. J. Craveiro de Carvalho

Departamento de Matem\'atica - Universidade de Coimbra

3000 Coimbra - Portugal.

\bigskip





\end{document}

