Registration

Registration Form

Contact Information:

First name:
Family name:
Institution:
Department:
Address:
City:
State:
Postal code:
Country:
Phone number:

Contact email
(will be used for communication about registration and for announcements):

Repeat email:
Participant's Email
(if different from contact email; will be used for List of participants):
Gender: Female Male
Dietary requirements (if any):

Type of registration:

Early registration (on or before February 27, 2015)* 330 EUR

Late registration (after February 27, 2015) 400 EUR

Industry registration** 650 EUR

Accompanying person 100 EUR

Free registration (CO members, speakers, other free registrations)

* For participants from Universities or research institutes, governmental nonprofit organizations, hospitals;
** Participants from companies should use Industry registration

Billing Address:

(Please note that the payment of registration fee can be performed by wire transfer only after receiving an invoice per email):

Institution:
Address:
Postal code:
City:
Country:
VAT (tax identification) number of the Institution:
(Mandatory for participants from EU member states; if you are not from EU member state, please enter "not applicable")

Comments for ICDS secretariat: