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]