Registration Form

General Information

Family Name:		First Name:
Institute:		Country:
Email:		Phone:

Will you have lunch at the workshop ?     Yes     No

If yes, please indicate the number of meals/tickets required (including yourself and accompanying persons)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

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Social Program

Will you attend the Workshop Dinner ?     Yes     No

Please, indicate the number of accompanying persons that will attend the social events

Welcome Cocktail:

0 1 2

Visit to Valencia:

0 1 2

Workshop Dinner:

0 1 2

Information about Social Events

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Total fee for early registration (€)    

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Accomodation

Arrival Date:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Departure Date:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Month:    November

Hotels:

No Hotel ExpoHotel Confortel Aqua 4* NH Las Artes Confortel Aqua 3* Express Las Artes NH Abashiri Venecia Ibis Valencia

room

Single Double

Information about Hotels

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Payment (both ways either credit card or bank transfer are possible)

Please indicate the credit card type or "bank transfer":
If credit card, give number:
and expiration date:

To confirm your reservations please fill this form and fax it to +34 96 310 6787 (Tot Nou)
In case of bank transfer don't forget to put your name to identify the payment

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Other comments & request for grants

Please add here the following information:
- request for a student grant if wanted together with some short report supporting your application (motivation, present activities, etc..),
- the name of your accompanying persons,
- any other information that does not fit anywhere else in this form.