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Registration Form
 PERSONAL DATA
Mr. Ms.
First Name:
Family Name:
Identity document:
Number:
Nationality:
Date of birth:
Format: dd/mm/yy
Personal Address:
Zipcode:
City/Town:
Province / Country / State:
Tel.:
Fax:
E-mail:
Repeat E-mail:
Institutional affiliation - Department Company:
Title (Dr/Prof):
Terms:
Required fields
INVOICE DETAILS (if different than the above)
Initially the invoice will be fill in with the information provided in this registration form. If you need any change in your invoice, please use the box below:
Institution Name:
Institution Address:
Zipcode:
City/Town:
Province:
Tel.:
Fax:
E-mail:
VAT Number

 REGISTRATION
   
Before April 5, 2014
After April 5, 2014
Standard (**)
485,00 €
555,00 €
Postgraduate Students (full conference fees) (**) (****)
395,00 €
485,00 €
IEEE/ AEPIA members (**)
395,00 €
485,00 €
Programme Committee (**)
315,00 €
405,00 €
Postgraduate Students1 (without dinners) (***) (****)
315,00 €
405,00 €
Accompanying person (*)
235,00 €
235,00 €
Seconds contributions in HAIS'14
125,00 €
145,00 €
Additional page (4 pages max.) (*****)
150,00 €
150,00 €
(*) Includes lunches and dinners.
(**) The Standard, Programme Committee, POSTGRADUATE STUDENTS (Full conference fees), AEPIA/IEEE members registrations include lunches and dinners.
(***) The POSTGRADUATE STUDENTS (Without dinners) registration includes lunches.
(****) Postgraduate students must provide proof of their status with a copy of their student card sent with the registration form. The document has to be presented when collecting the documentation.
(*****) A charge of 150€ will be applied for each extra page (up to a maximum of 4 extra pages).

 HAIS CONTRIBUTION:

I DO NOT SUBMIT ANY CONTRIBUTION

1st CONTRIBUTION  
Id:
Nº Additional Pages (1, 2, 3 or 4)
Title: €150 for each additional page
2nd CONTRIBUTION  (Before April 5, 2014: €125 / After April 5, 2014: €145)
Id:
Nº Additional Pages (1, 2, 3 or 4)
Title: €150 for each additional page
3rd CONTRIBUTION  (Before April 5, 2014: €125 / After April 5, 2014: €145)
Id:
Nº Additional Pages (1, 2, 3 or 4)
Title: €150 for each additional page
4rd CONTRIBUTION  (Before April 5, 2014: €125 / After April 5, 2014: €145)
Id:
Nº Additional Pages (1, 2, 3 or 4)
Title: €150 for each additional page
5rd CONTRIBUTION  (Before April 5, 2014: €125 / After April 5, 2014: €145)
Id:
Nº Additional Pages (1, 2, 3 or 4)
Title: €150 for each additional page

 ADDITIONAL INFORMATION – Food intolerances:
Vegetarian
Strict vegetarian
Celiac
No pork
Other

 HOW TO PAY:
Bank Transfer

Bank transfer for CONFERENCE FEES, payable to CAJA ESPAÑA - CAJA DUERO BANK

Account Number: 2104 / 0014 / 59 / 9164035006.
IBAN: ES36 2104-0014-59-9164035006
B.I.C. / Swift Code: CSSOES2S

Owner of the Account Number: (Technical Secretariat)
CONGRESUAL, S.L.L. (VAT number: B-37495116)
Address: C/ Camelias, 470 -37449 –Galindo y Perahuy (Salamanca) Spain.

Send a copy of the transfer to this newsletter indicating the concept of payment by email to the mailbox: haisregistro@usal.es


Only VISA or MasterCard Credit Cards
You will be transferred directly to the secure on-line payment. (directly with the bank)
This process will be done through the secure area of the bank.
This is an automatic process. If you have any problem, please contact with you bank


 VALIDATION CODE
Validation Code:
Generar nuevo código
Salamanca on 11th-13th June 2014
Springer
IEEE Systems, Man & Cybernetics Society - Spain
University of Salamanca
BISITE Research Group

© 2013 Multimedia Team
Salamanca, Spain 2013