FAX conference registration form

1) Personal Details: (Please fill in Capital letters)
Title
First Name
MI.
Fax this form to:
VIAJES EL CORTE INGLES
Last / Family Name
Department
División Congresos
Ref. COLA 2007,
C/ Princesa 47, 5ª. Planta
28008, Madrid, SPAIN
Phone: +34 91 204 26 00
Fax +34 91 547 33 24
[email protected]
Institution/Company
Address
City
Zip/Postal Code
Phone
Country
Fax
E-Mail
2) Conference Registration:
Check box to indicate appropriate registration fee:
Full registration fee:
Student registration fee:*
Before 18 July 2007
Reduced industrial sponsor fee: (2 consecutive days)*
24
25
26
27
28
Excursion & Conf. Dinner (Sept. 26) per accompanying person:**
After 18 July 2007
460 €
220 €
560 €
320 €
220 €
320 €
80 €
80 €
• Registration fee:
(full/student/industrial)
* DOES NOT include Proceedings. Students have to give evidence for University registration.
** Price for accompanying people NOT REGISTERED at the conference.
Registration fee includes admittance to the conference, coffee breaks, lunches at auditorium, refreshments at poster sessions,
xcursion & conference dinner (you must pre-register for it) and a volume copy of proceedings except as indicated *
I will attend the excursion & conference dinner with
accompanying people
will attend the excursion &
Conference dinner
TOTAL:
€
€
€
accompanying people.
As part of the excursion, I’m interested in visiting the Teide Observatory (Astrophysics Institute of Canarias, IAC). There are a limited number of seats for this
visit and thus it is only available for people registered at the Conference. The seats will be allocated on a first come, first served basis.
I plan to get lunch at the conference site on
3) Proceedings order:
September 24
September 25
September 26
September 27
Proceedings copy of my choice:
Laser Ablation: Fundamentals
Laser processing
(one proceeding volume per registered person)
Materials growth by Pulsed Laser Deposition
Lasers in Nanoscience, Analysis & Applications
4) Payment Method:
Check box to indicate payment method. Payments will be charged in €.
Bank transfer:
Payment should be made in € for the net total amount due. Bank transfer
free of fees to:
Account: VIAJES EL CORTE INGLES
Ref:
COLA 2007
Bank:
BANCO BILBAO VIZCAYA ARGENTARIA
IBAN:
ES97 0182 3999 37 0200664662
SWIFT: BBVAESMMXXX
Please send a copy of the bank transfer, including the sender’s name, by
fax to:
COLA 2007, VIAJES EL CORTE INGLES,
Fax number: +34 91 547 33 24.
NO REGISTRATION WILL BE PROCESSED WITHOUT THIS COPY.
Credit Card:
I authorize to charge the amount of
VISA
EL CORTE INGLÉS
DINERS
€ to my credit card:
AMEX
MASTERCARD
CARD NUMBER:
Expiration Date:
(Month/Year)
Credit card holder:
Date and Signature:
NO REGISTRATION WILL BE PROCESSED IF your signature is not included when
paying by credit card. Please complete all information.
Print Form
This form has to be faxed to : (+34) 91 547 33 24. E-mail submissions will NOT be considered
Refund policy and cancellation: Cancellations received before September 1, 2007 will be refunded less 30 € for handling fees. No refund will be applicable after that
date; however, the change of registered person will be accepted. Cancellation requests should be sent to the same address than registrations.