Registration Form - Lisboa
Transcrição
Registration Form - Lisboa
Registration Form Personal Info Name: Address: NIF (Portugal citizen only): City: Zip code: Country: Institution: E-mail: Phone: Invoice Info (mandatory fields) Bill to: Address: City: Zip code: Country: VAT Number (if registered in EU only): Conference fees Advance Registration (before November 1st) Please, choose one of the following six options: Regular Students CFCUL’s integrated members Registration Fee (without Conference Dinner) [ ] 100 Euros [ ] 50 Euros [ ] Free Registration Fee (includes Conference Dinner) [ ] 125 Euros [ ] 75 Euros [ ] 25 Euros Late Registration (between November 1st and November 15th) Please, choose one of the following six options: Regular Students CFCUL’s integrated members Registration Fee (without Conference Dinner) [ ] 150 Euros [ ] 75 Euros [ ] 25 Euros Registration Fee (includes Conference Dinner) [ ] 175 Euros [ ] 100 Euros [ ] 50 Euros Payment Conditions Bank Transfer Bank details: Account holder: Fundação da Faculdade de Ciências da Universidade de Lisboa Account number: 91120000081 IBAN: PT50 0781 0112 9112 0000 0813 2 SWIFT CODE: IGCPPTPL Bank name: Agência de Gestão da Tesouraria e da Dívida Pública - IGCP, E.P.E. Branch address: Av. da República, nº 57, 6º, 1050-189 Lisboa Reference: Name, Conference title § The Conference title and your name should be clearly mentioned in the bank transfer’s form. Payments with missing information may not be considered. § Transfer confirmation together with this registration form must be sent by e-mail to: [email protected]. § The total amount of the fee should be credited to the conference organizer in one payment. § The sender must pay all appropriate bank transfer charges in addition to the registration fee. Credit Card Please use to the following link: https://pagamentos.redunicre.pt/3024294/fundacaofaculciencias/ § We can only accept Visa or MasterCard. § Transfer confirmation together with this registration form must be sent by e-mail to: [email protected]. By Check Must be addressed to: Att: Susana Amaral In order to: “Fundação da Faculdade de Ciências da Universidade de Lisboa” Address: Edifício C1, Piso 3, Campo Grande, 1749-016 Lisboa, Portugal § All checks should be in euros. Registration form Send this registration form by e-mail to: [email protected]
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Account holder: Fundação da Faculdade de Ciências
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