FAX conference registration form
Transcripción
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.