AFM BioMed Conference Krakow 2017 Registration Form


Title:

First Name:
*
Last Name:
*
Institution:
*
Address:
* Post Code:*
City: * Country: *
E-mail:
*
Confirm E-mail:
*


Invited speaker or Grant (no fee)

Conference fee:



Vegetarian diet



Invoice Address:

Institution:

Address:
Post code:
City: Country:

EU VAT Number:
*
If you do not have EU VAT Number please put "no vat number"


*) - obligatory

Comments:


Please transfer your payment to:

Wydzial Fizyki, Astronomii i Informatyki Stosowanej Uniwersytet Jagiellonski ul. Golebia 24
31-007 Krakow, Poland
Bank Account number: PL 07 1240 4722 1111 0000 4855 9692
SWIFT code: PKOPPLPW
Bank name: PEKAO S.A.

Deadline for early registration and payment is July, 10 2017.

In the case of payment after the July 11 conference fee increases by 100 EUR

Please write clearly on the bank draft: YOUR NAME and AFM BioMed 2017.
Please note that any bank charges must be covered by a sender!

Cancellation fees:
50EUR before August 1, 2017,
200 EUR before August 31, 2017,
No reimbursement after August 31, 2017