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[pic] |PFN 2006 Registration Form
| |
1. Identification
|Surname: |First Name: |
|Title: |Institution: |
|Address: |City: |
|Post Code: |Country: |
|Telephone: |Fax: |
|E-Mail: |
2. Registration Fee
| |Before June 9, 2006 |Before July 5, 2006 |Conference Days |
|Academic Participants |200.00 € |250.00 € |300.00 € |
|Ph.D. Students |100.00 € |125.00 € |150.00 € |
|Other |300.00 € |350.00 € |400.00 € |
(The registration includes the social events below for the registrant)
Total for Registration (A): Euros
3. Accommodation
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(Rates are per room, per night, including breakfast and taxes)
|Hotel: |Number of Rooms: |
|Date of Arrival: |Date of Departure: |
|Do you have any special requirements, needs or comments? |
Nr. of Rooms x Nr. of Nights x Hotel Rate =Total for Accommodation (B): Euros
4. Social Events
Please indicate which of the following events you (and your spouse) plan to attend:
Thursday Reception: Self (0 €) Spouse (0 €)
Friday Gala Dinner: Self (0 €) Spouse (30 €)
Total for Social Events (C): Euros
5. Tours
| |Price |Nº of Persons |
|Visit to "Casa de Serralves" – Saturday (14:30 – 18:30) |€ 26 | |
Total for Tours (D): Euros
6. Payment
Payment can be done by a Bank Draft issued to Viagens Abreu S.A. (please contact Viagens Abreu, for further details), or by Credit Card. For payment by Credit Card, please fulfil:
I authorise to charge the total amount of (A+B+C+D) Euros to my: VISA / AMERICAN EXPRESS / MASTERCARD number . Expire Date:
Last three numbers of the backside of the credit card(CVV)
Signature (of Card Holder): ______________________________________________
| |
|Please send this Form to: Viagens Abreu S.A. / Att. Congress Dept. / Av. dos Aliados 207 / 4000-067 Porto – PORTUGAL / |
|Phone:00.351.22.204 3570 / Fax : 00.351.22.204 3693 / E-mail: congress.porto@abreu.pt |
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