Registration form 25. to 27. September 2013 Wrocław & Złoty Stok, Poland registration conference fee



Pobieranie 11.57 Kb.
Data06.05.2016
Rozmiar11.57 Kb.
RodzajRegistration form
GEOTOUR 2013 & IRSE 2013

REGISTRATION FORM

25. to 27. September 2013

Wrocław & Złoty Stok, Poland
REGISTRATION - CONFERENCE FEE (150 €/PERSON)

Name, surname, title

……………………………………………………………...



University / Company name

……………………………………………………………...



Address, city, ZIP code, country

……………………………………………………………...

……………………………………………………………...

E-mail

……………………………………………………………...



Contact phone

……………………………………………………………...



TITLE OF THE PAPER

………………………………...........................................................................................................................................

………………………………...........................................................................................................................................

ACCOMODATION ORDER

Please cross the box as appropriate


Gold Stok” Hotel
in Złoty Stok


Type of the room

Single

1 person/room



Double

2 persons/room



25./26. September 2013







26./27. September 2013








REGISTRATION FEE PAYMENT DETAILS

Standard fee: 150 EURO/person

Author in absentia fee: 25 EURO/person

The Registration fee should be sent by 21. August 2013 to:

Bank name: Bank Zachodni WBK S.A.

Bank address: ul. gen. Wł. Sikorskiego 2-8, 53-659 Wrocław, Poland

Owner of account: KGHM CUPRUM Ltd

Account No:

11 1500 1155 1211 5006 8149 0000 – if paying in EURO

24 1500 1155 1211 5006 8123 0000 – if paying in PLN

SWIFT: KRDBPLPW

Payment/transfer title: GEOTOUR 2013, Participant name and surname



Date, signature

…………………………………….




©absta.pl 2019
wyślij wiadomość

    Strona główna