Registration form


Rejestracja i opłaty dla osób z Polski (registration for Polish participants)

First name*
Last name*
Title
Company/institution*
Department
Full address*
Full mail address (if different)
E-mail*

Fee  
 Early*Late
 Workshops registration80 €100 €
 Conference registration350 €400 €
 Workshops + conference400 €450 €
 Workshops registration for students30 €50 €
 Conference registration for students130 €160 €
 Workshops + conference for students180 €210 €
 PhD consortium50 €70 €
 PhD consortium + conference150 €180 €
 1-day conference registration fee, without paper
    (social event included)		100 €100 €
Early registration deadline: June 25th, 2012

Payment information
Bank: PEKAO SA II O/Poznań
ul. Masztalarska 8a, 61-767 Poznań
Account: SWIFT Code - PKOPPLPW
IBAN - PL56 1240 1763 1978 0000 1812 7816
Account holder: Politechnika Poznanska
pl. Marii Sklodowskiej-Curie 5, 60-965 Poznań
Title: Participation in ADBIS 2012 Last name first name
All bank fees must be paid by the participant
On site payment: cash only

I need an invoice
Payer's institution name
Payer's institution address
Payer's city and country
Payer's institution VAT number (optional)

Arrival date (yyyy-mm-dd)
Departure date (yyyy-mm-dd)
I am vegetarian