XXV Scientific Instrument Symposium

September, 10-14 2006

Krakow, Poland

 
Please mail or fax (both sides) this completes form to the conference agency :

Jagiellonian University BOIN,

Gołębia 24, 31-007 Kraków, Poland

Fax/phone: + 48/12/ 421 26 62

Phone: +48/12/ 663 38 58

 
   

           Registration Form

(Please send this form before 2 May, 2006)

Personal Data

 

 

 

1. Participant

Surname:
First Name:
Institution:

Street Address:
Postal code City
Country:
E-mail:
Phone:
Fax:
Surname of the Accompanying Person:
First Name of the Accompanying Person

1. Type of presentation

Oral
Poster
Oral title:
Poster title:

3. I will use:

PowerPoint Projector
Slide Projector
Overhead Projector

 1. Conference fee

 

Before May 2

After May 2

Regular

 EUR 190 EUR 250
Accompanying EUR 110 EUR 150
Number of Accompanying Persons  

 

3. Travel:

Date of arrival:

 

 

Date of departure:

I intend to arrive to Krakow by:

plain
Yes  No
train
Yes No
bus
No
car
No

4.Official dinner (Thursday September 14; extra cost 45EUR )

Yes No

5. Post-Conference Excursion (Friday September 15; extra cost 50 EUR or 40EUR)

Please indicate your choice for the excursion:

I Wieliczka Salt Mine (50 EURO)
II Auschwitz-Birkenau Camp (50 EURO)
III Krakow - sightseeing tour (40 EURO)

Please indicate a second choice for the excursion in case your selection above is no longer available:

I II III
Presentation
 

 

 

 

Fees/

Accommodation
 
Total payment

Participant:

1. Registration fee EUR
2. Official dinner EUR
3. Post-Conference Excursion EUR
4. Total EUR

Accompanying Person:

1a. Fee EUR
2a. Official dinner EUR
3a. Post-Conference Excursion EUR
4a. Total EUR

 

Total payement

 (participant and accompanying person 4+4a) EUR

 

PAYMENT CAN BE MADE AS FOLLOWS:

All the costs payable to the Jagiellonian University - XXV SIC Symposium  should be send to:

Jagiellonian University BOIN, ul. Gołębia 24, 31-007 Kraków, Poland

100% refund of fee is possible (minus banking charges associated with the transfer) before the 1st August 2006. After this date no refunds will be possible.

 

Invoice request - please send by fax. (+ 48/12/663 38 58)

Please indicate which of the following means of payment you are using (in case of a bank transfers, please cover the banking charges).

 

Bank transfer to:

Beneficiary: Jagiellonian University BOIN,

Bank:

BPH S.A. o/Kraków IBAN: PL 75 1060 0076 0000 3300 0015 7610,

SWIFT: BPHK PL PK

(please indicate SIC as well as the name of the participant. Don't forget to bring your copy of document confirming that the payment has been done)

 

Credit card (VISA, Mastercard, American Express etc.)

Card details- please send by fax. (+ 48/12/663 38 58)

Please send us a copy of the payment confirmation