Please click
here in order to download the form
and return it to us by fax or e-mail (as attached file)
or submit the online form below.
Please note that the electronic submission is
encouraged.
Participant's
details
Title:
Last Name:
First name:
Address:
Country:
Phone:
Fax:
E-mail:
Event
Conference Dinner
60 EUR
Form of Payment
I
have ordered a bank transfer (In this case
please send us by fax or e-mail a copy of the
receipt of the bank transfer order)
Receiving bank
details
Bank name and
address:
NATIONAL BANK OF GREECE
OMONOIA SQUARE
PATRAS, GREECE
Bank account
number: 229/51221989
Currency code EURO
Code BIC (SWIFT address) (obligatory):
ETHNGRAAXXX057191
COS IBAN: GR9601102290000022951221989
Name of beneficiary:
Professor Demos T. Tsahalis
3rd IC-SCCE - LFME, University of Patras
University Campus, GR-26500, Patra
Please
charge the amount of
EUR to
my Credit Card:
VISA
or
MASTER CARD
Card number:
Expiry date:
CardHolder's Name:
CVV2 *
All Bank fees must be covered by
the sender
Please indicate the name of the
participant and the code "3rd IC-SCCE Conference"
*: CVV2 Is the last 3 digits on the backside of your
credit card on the signature strap.
Cancellation
All cancellation must be made in writing to the
Conference Secretariat. For Cancellation received by 31
May, 2008 a refund of 80% will be granted. No refunds
will be made for cancellations after that date.
The conditions of this registration
are hereby fully accepted.
