Passion for Knowledge - Quantum 13 - , 30 Sept - 6 Oct 2013, Basque Country

Registration

PERSONAL DETAILS (One form per participant)

Surname:*
Name:*
Organization:*
Telephone:*
E-mail:*

INVOICING DETAILS

Invoice to an individual

Invoice to a company/institution/University

Organization / Name and Surname:*
Address:*
City:*
Post Code:*
Telephone:
Email to receive the invoice:*

Please, insert just numbers and letters, avoiding any kind of sign or spaces
Country:*
VAT number / Tax ID / EIN# / Passport / ID number:*
Only for European companies: It is essential to indicate us the valid intra-Community VAT Number. Otherwise you must pay the fee + 21% VAT To check, click here: http://ec.europa.eu/taxation_customs/vies/

REGISTRATION FEE

Regular:	165,29 € + VAT
21% VAT not included, 165,29€ + VAT(21%) = 200€ Registration fee includes: attendance to the Technical Sessions, a book of abstracts, coffee breaks, conference dinner, free attendance to the Quantum 2013 Symposium and VAT.

I require a Letter of Invitation to attend BRW 2013 to apply for a VISA.

ACCOMMODATION

The prices given are per room and per night, breakfast and taxes included. Total Payment is required to obtain confirmation of reservation. Final Reservation date: Sept. 2

	Single room	Double room
NH Aranzazu **** breakfast included	104.50 €	118.80 €
NH Aranzazu **** no breakfast	90.20 €	90.20 €
Monte Ulia * breakfast included	67.00 €	87.00 €
Monte Ulia * no breakfast	62.00 €	77.00 €
No accommodation.

Arrival date:
Departure date:

SPECIAL NEEDS

If you have any disability or special dietary requirement, please specify:

PAYMENT

Bank transfer

Banco Banesto
IBAN: ES79-0030-3469-1500-0074-0271 SWIFT CODE: ESPCES MMXXX
BANESTO, c/Miracruz, 13 20001 Donostia-San Sebasti�n, Spain
Ref. QUANTUM - BRW 2013 - your name

Please send the copy of the bank transfer document, indicating the participant name to LANKOR (Fax: +34 943 42 80 55 or e-mail: brw_register@quantum13.eu).

Credit card

Registration: The latest registration date will be September 16th. Limited places.

Cancellations: No returns will be made for cancellations after August 30th.

In accordance with the provisions set for in article LO 15/98 of Personal Data Protecting Policy, you are hereby informed that any personal data provided by you will be attached to a document whose responsability belongs to DIPC, just for promotion purposes and any derivates therefrom. By filling out the present form DIPC and Lankor S.L. are hereby authorised to use the provided personal data for the above mentioned purpose. Likewise, you will be entitled to access, alter and cancel it, in your particular case, at our offices.

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