The First International Conference on:
SCIENCE MATTERS: A Unified
Perspective
Ericeira, Portugal
28-31 MAY 2007
Registration Form
Please print, complete and fax to: Conference Secretariat
+351 239 855589
First Name
Last Name
Job Title
Scientific Name
(for Badge)
Institution
Mailing Address
Postal Code
City
Country
Phone
Fax
Email
Number of accompanying persons:
First Name
Last Name
Have you submitted or plan to submit an abstract?
YES
NO
Conference Fee
The conference fee covers admission to the Conference, Welcome Cocktail on
28 May, coffee breaks during the Three days presentations, printed programme
and book of abstracts.
In order to book accommodation, please contact: Vila Galé Ericeira Hotel
Registration will not be processed without proof of payment.
Method of Payment:
check
check must be drawn on a Portuguese bank and payable in euros.
Please make your check payable to:
Centro de Estudos Sociais
Colégio de S. Jerónimo
Apartado 3087
3001 - 401 Coimbra – Portugal
check No _____________________________________________________
Date: ________________________________________________________
Bank
Transfer Bank transfer must be net of costs.
Please include your name in the bank transfer information.
Account holder: Centro de Estudos Sociais
Bank: Caixa Geral de Depósitos (Coimbra, Portugal)
IBAN: PT50 0035 0671 1234 0311 3307 5
NIB: 0035 0671 1234 0311 3307 5
BIC: CGDIPTPL
VISA
Mastercard
Card Holder:
Card Number:
Expiry Date:
Security CodeCVV:
Signature:
Date: