18th-20th April of 2016
Seville, Spain
Organizers
Technical Co-sponsors
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/Student):
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:
-The official invoice will be provided directly in the congress-
Institution Name:
Institution Address:
Zipcode:
City/Town:
Province:
Tel.:
Fax:
E-mail:
VAT Number
Please, you should complete the Identity Document or the Vat Number for your invoice.

 REGISTRATION
   
Before February 9, 2016
After February 9, 2016
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 Students (without dinners) (***) (****)
315,00 €
405,00 €
Accompanying person (*)
235,00 €
235,00 €
Seconds contributions in HAIS'16
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).

  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 February 9, 2016: €125 / After February 9, 2016: €145)
Id:
Nº Additional Pages (1, 2, 3 or 4)
Title: €150 for each additional page
3rd CONTRIBUTION  (Before February 9, 2016: €125 / After February 9, 2016: €145)
Id:
Nº Additional Pages (1, 2, 3 or 4)
Title: €150 for each additional page
4rd CONTRIBUTION  (Before February 9, 2016: €125 / After February 9, 2016: €145)
Id:
Nº Additional Pages (1, 2, 3 or 4)
Title: €150 for each additional page
5rd CONTRIBUTION  (Before February 9, 2016: €125 / After February 9, 2016: €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

 ONLY FOR ALREADY REGISTERED USER
When you register you will receive a registration code and a password that should be used if you wish to register an accompanying person in the future
Complete the following fields and click COMPLETE DATA to register an accompanying person.
Registration Code
Password:
 HOW TO PAY
Bank Transfer

Bank transfer for CONGRESUAL S.L.L. 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.

Attach a copy of the transfer to this newsletter indicating the concept of payment by email to the mailbox: haisregistration@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 your bank.


 VALIDATION CODE
Validation Code:
Generar nuevo código

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