mis4TEL'14 | Methodologies and Intelligent Systems for Technology Enghanced Learning

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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:

Regarding the L.O.15/1999 law of December 13, which deals with the treatment of personal information and databases, we would like to inform you of the following:
 
 A.- The data provided by the user will be added to a database which is kept, owned and managed by Congresual SLL, and Congresual SLL the responsible party for any use of such information. The fiscal information of Congresual SLL is: CIF B-37495116 and address: C/ Camelias 470 .  CP 37449  Galindo y Perahuy (Salamanca). The database is being registered in the General Register for Databases and it has the required code, which is assigned by the Spanish Data Protection Agency.
 
 B.- Congresual SLL guarantees the confidentiality of all the information provided by the user. The obtaining and management of the data is done following strict levels of security apart from the levels required by law in order to assure that such confidential information may not be lost nor obtained by a third party.
 
 C.- Following the current legislation, all users of Congresual SLL Server have the right to enter, modify or cancel his/her personal data. If the user chooses to cancel the personal information previously given to Congresual SLL, after the user logs off, all confidential information will be erased from the system, except information related to historical or statistical purposes.
 
 In order to modify the previously mentioned information, the user must do so in writing, by sending a formal allowance to Congresual  by regular mail to the following address:
 
 Congresual SLL, C/ Camelias 470 .  CP 37449  Galindo y Perahuy (Salamanca)

I have read and I agree the terms that appear in this registration form

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 March
10 31, 2014

After March
31, 2014

Standard

485,00 €

555,00 €

Postgraduate Students¹ (full conference fees)

395,00 €

485,00 €

IEEE/ AEPIA members²

395,00 €

485,00 €

Programme Committee

315,00 €

405,00 €

Postgraduate Students¹ (without dinners)

315,00 €

405,00 €

Accompanying person
(includes lunches, coffee breaks and social programme)

235,00 €

(1) A copy of his/her student ID or index as a proof of student status is required.
(2) A copy of his/her IEEE / AEPIA members card is required.

The first contribution is included with the registration, the cost of additional contributions in Mis4TEL or its associated events (special sessions or workshops) as well as in the collocated events (PAAMS, DCAI, PACBB, ISAmI) is 125€ before March 31th or 145€ after March 31th

MIS4TEL CONTRIBUTION:

I DO NOT SUBMIT ANY CONTRIBUTION

1^st CONTRIBUTION

Id:

Nº Additional Pages (1, 2, 3 or 4)

Title:

€100 for each additional page

2^nd CONTRIBUTION (Before March 31, 2014: €125 / After March 31, 2014: €145)

Id:

Nº Additional Pages (1, 2, 3 or 4)

Title:

€100 for each additional page

3^rd CONTRIBUTION (Before March 31, 2014: €125 / After March 31, 2014: €145)

Id:

Nº Additional Pages (1, 2, 3 or 4)

Title:

€100 for each additional page

OTHER CONTRIBUTION TO COLLOCATED EVENTS:

I DO NOT SUBMIT ANY CONTRIBUTION

1^st CONTRIBUTION (Before March 31, 2014: €125 / After March 31, 2014: €145)

Id:

Event:

Title:

Nº Additional Pages (1, 2, 3 or 4)

€100 for each additional page

2^nd CONTRIBUTION (Before March 31, 2014: €125 / After March 31, 2014: €145)

Id:

Event:

Title:

Nº Additional Pages (1, 2, 3 or 4)

€100 for each additional page

3^rd CONTRIBUTION (Before March 31, 2014: €125 / After March 31, 2014: €145)

Id:

Event:

Title:

Nº Additional Pages (1, 2, 3 or 4)

€100 for each additional page

4^rd CONTRIBUTION (Before March 31, 2014: €125 / After March 31, 2014: €145)

Id:

Event:

Title:

Nº Additional Pages (1, 2, 3 or 4)

€100 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: registrationusal@congresual.com

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

Validation Code:

SALAMANCA, 04/06
JUNE 2014

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IEEE Systems, Man & Cybernetics Society - Spain

Centre national de la recherche scientifique