Registration Form

Workshop
Microscale Modeling in Biomechanics
and Mechanobiology
Ericeira, Portugal
May 30 – June 1, 2011
REGISTRATION FORM
First name:
Last name:
e-mail:
Address:
City:
Postal code:
Country:
Fax number:
INVOICE DATA
Name:
Address:
Postal code:
Country:
VAT Number:
REGISTRATION FEE: 430€ (ESB Members 400€)
Payment Bank Transfer
Credit Card Payment
Bank Information:
Account: IDMEC - Instituto de Engenharia Mecânica
Bank:
BPI
Address: Balcão Instituto Superior Técnico
Av. Rovisco Pais, 1, 1049-001 Lisboa
Account Number:
NIB:
IBAN:
2-3386706.001.001
0010 0000 33867060101 59
PT50 0010 0000 3386 7060 1015 9
SWIFT/BIC:
Register now
Information will be given later
BBPIPTPL
Please identify the operation with the reference
“MBIOMECH+First Initial+Last name” and send us a copy of the
Bank Transfer by email: [email protected]
(bank charges, which might be incurred, must be met by the participant)
Please email the registration form to “[email protected]” (pdf format)
Confirmation will be sent by e-mail.
Important:
For Hotel Vila Galé - Ericeira room reservation contact Mrs. Catarina Peixoto at “[email protected]”
(Phone: +351 217907643) with Arrival/Departure dates, room type (Single/Double) and reservation code:
“Microscale modeling Biomech 30th May”. Room guarantee deadline is March 28, 2011.
Hotel description at: http://www.vilagale.pt/pages/hoteis/?hotel=10