Registration Form

REGISTRATION FORM
23-24 January 2015, ISEG; Lisbon
Please complete and return this form to:
CEMAPRE
Rua do Quelhas, 6
1200-781 Lisboa, Portugal
Fax +351213922782
Email: [email protected]
Contact Details
First Name
Surname
Institution
E-mail
Phone
Workshop Registration (Registration fee is per person and includes the attendance at the Workshop and
Workshop materials. Lunches and coffee breaks will be provided by the organizers to the registered
participants.)
Regular participant
Students*
Before December 22nd
150 €
After December 22nd
200 €
75€
125€
* Students must send a letter from the Head of Department / Director of Doctoral School confirming the student status.
Dietary requirements (For catering purposes at the workshop, please indicate if you have special dietary
requirements.)
No
Yes
If yes, please specify _____________________________
Workshop dinner (The workshop dinner is not included. If you wish to purchase the dinner at 45€ per
person, please indicate below.):
Number of tickets
Name Badge (Please indicate the contact details for your name badge at the workshop. If different from
above.)
First Name
Surname
Institution
PAYMENT
Payment Summary
Registration
Workshop dinner
TOTAL
_______ Euros
_______ Euros
_______ Euros
Payment Method
Payment of the workshop fees can be done either by cheque or by bank transfer.
Cheque
A cheque in Euros made payable to CEMAPRE and accompanied by the full details of the participant
should be posted to the following address:
CEMAPRE,
Rua do Quelhas 6
1200-781 Lisboa, Portugal
Transfers from bank accounts
In Portugal:
Account owner: CEMAPRE
Address: Rua do Quelhas 6, 1200-781 Lisboa, Portugal
Bank: Caixa Geral de Depósitos, Agência do ISEG
Bank Address: Rua das Francesinhas, Edifício novo do ISEG, 1200-781 Lisboa, Portugal
NIB: 003503710000441043085
Outside Portugal:
A banker's order transfer should be made to the following current account:
Account owner: CEMAPRE
Address: Rua do Quelhas 6, 1200-781 Lisboa, Portugal
Bank name: Caixa Geral de Depósitos, Agência do ISEG
Bank Address: Rua das Francesinhas, Edifício novo do ISEG, 1200-781 Lisboa, Portugal
IBAN: PT50003503710000441043085
BIC SWIFT: CGDIPTPL
Important:
Please make sure that the transfer includes a reference to the name of the participant.
Alternatively, you can send a copy of the order to CEMAPRE by fax, a digital scan by e-mail or a bank email.
Possible bank charges will be supported by the payer.