VURUP - 40th IPC - Registration Form A

Registration Form A

Delegate

Title:
Surname:
First name:
Company/Organization:
Department:
Address:
Postal code:
Country:
Tel.:
Fax:
E-mail:

Registration Fees

		Price
	Delegate	USD
	1^st Author of paper	USD
	1^st Author of poster	USD
	Price total	USD

Payment: the total amount will be paid by:

Bank transfer account:	Bank: VÚB, a.s., pobocka Ruzinov, expozitúra Vlcie Hrdlo, 824 12 Bratislava, Slovak Republic, P-SSPCH
	Account number: 1156966359/0200, (SWIFT:SUBA SK BX)
	With reference: 0901

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