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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/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:
Institution Name:
Institution Address:
Zipcode:
City/Town:
Province:
Tel.:
Fax:
E-mail:
VAT Number

 REGISTRATION
   
Before April 6, 2017
After April 6, 2017
Standard (**)
485,00 €
555,00 €
Postgraduate Students (full conference fees) (**) (***)
395,00 €
485,00 €
Accompanying person (*)
235,00 €
235,00 €
Additional contributions
125,00 €
145,00 €
Additional page (4 pages max.) (****)
100,00 €
100,00 €
(*) Reduced rates are mainly applicable to accompanying persons (includes lunches and dinners).
(**) The Standard, POSTGRADUATE STUDENTS (Full conference fees) registrations include lunches and dinners.
(***) 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 100€ will be applied for each extra page (up to a maximum of 4 extra pages).

 NB&PL CONTRIBUTION:

I DO NOT SUBMIT ANY CONTRIBUTION

1st CONTRIBUTION  
Id:
Nº Additional Pages (1, 2, 3 or 4)
Title: €100 for each additional page
2nd CONTRIBUTION  (Before April 6, 2017: €125 / After April 6, 2017: €145)
Id:
Nº Additional Pages (1, 2, 3 or 4)
Title: €100 for each additional page
3rd CONTRIBUTION  (Before April 6, 2017: €125 / After April 6, 2017: €145)
Id:
Nº Additional Pages (1, 2, 3 or 4)
Title: €100 for each additional page
4rd CONTRIBUTION  (Before April 6, 2017: €125 / After April 6, 2017: €145)
Id:
Nº Additional Pages (1, 2, 3 or 4)
Title: €100 for each additional page
5rd CONTRIBUTION  (Before April 6, 2017: €125 / After April 6, 2017: €145)
Id:
Nº Additional Pages (1, 2, 3 or 4)
Title: €100 for each additional page

 HOW TO PAY:
Bank Transfer

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

Account Number: 2108 2214 12 0036150464
IBAN: ES18 2108 2214 12 0036150464
B.I.C. / Swift Code: CSPAES2L

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: nbplregistration@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
Barcelona on June 28th-30th 2017
 
Springer
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Barcelona, Spain 2016