C E N 2 0 1 2

CEN2012 Conference
Carmona-Sevilla (Spain) 01 - 04 October, 2012

Registration Form

Gender(*)	Male Female
Title(*)	Mr./ Mrs./ Ms Dr./ Professor.
First Name(*)
Last Name(*)
Institution/Dept.(*)
Address(*)
City(*)
*ZIP Code()**
Country(*)
Phone(*)
Fax(*)
E-Mail(*)
Doctoral Student (*)

CEN2012 Conference Fees


	Before Sept 20		After Sept 20
Senior	250 Euros		350 Euros
Student	190 Euros		290 Euros

Exhibition Fees


	Before Sept 20		After Sept 20
Stand 2X2 (Space rental)	950 Euros		1150 Euros
Stand 3X2 (Space rental)	1150 Euros		1350 Euros
Stand 2X2	1200 Euros		1400 Euros
Stand 3X2	1450 Euros		1650 Euros

(*) Justification signed by your PhD Adviser should be sent by e-mail (antonio@phantomsnet.net)

Additional Info

Arrival Date: October 2012 Departure Date October 2012

Do you submit a contribution?

Vegetarian?

P A Y M E N T

(*)
(*) For Credit Card payment, a 3,5% (bank charges) will be applied.

1) Bank transfer to the order of "Fundacion PHANTOMS" must bear the mention "FREE OF CHARGE TO THE RECEIVER" and must indicate CEN2012 Conference and LAST and FIRST NAME of the participant to facilitate identification and to the following bank account:

    CAJA Navarra – Calle Alcalde Sainz de Baranda 64, 28009 Madrid – Spain
    I.B.A.N (International Bank Account Number): ES312054 0086 1691 4341 3533
    SWIFT / BIC (Bank International Code): CANVES2P
    Phantoms Foundation VAT Number: ES-G83352724

PLEASE, SEND BY Email (antonio@phantomsnet.net) A COPY OF YOUR BANK TRANSFER MAKING CLEAR THE NAME OF PARTICIPANTS TO CEN2012 CONFERENCE.
ALL BANK CHARGES SHOULD BE PAID BY THE APPLICANTS.

2) Credit card [ VISA - MasterCard ]


VISA	MasterCard

CANCELLATION OF CONFERENCE PARTICIPATION
All cancellations should be made in writing by e-mail to Antonio Correia (antonio@phantomsnet.net).
Your payment less 50 Euros will be reimbursed, if a cancellation is received between August 01 and August 20, 2012
50% of the registration fee will be reimbursed, if a cancellation is received between August 21 and September 17, 2012
No reimbursement will be made after September 17, 2012

INSURANCE
The Organisation Committee will not be responsible for any medical expenses, lost property, or accidents during the NanoSpain Workshop and we strongly recommend that participants make all necessary insurance arrangements for themselves.

Invited Speakers

Location & Venue

: P h a n t o m s F o u n d a t i o n 2 0 1 2 :