ATEE2017_RegForm

Registration Form

Personal Information

Prefix

Mr. Mrs.

Scientific Title

First Name

Last Name

Affiliation

Position

Address, City, Country

Paper ID

Please Select

Oral Presentation Poster Presentation

IEEE Membership Number

Phone

E-Mail

Participation Fee

(coffee breaks, conference documents, USB proceedings, lunch, get together party)

Participants registered by 03.03.2017

non-IEEE Members - 400 RON (or 90 EUR) IEEE Members - 350 RON (or 78 EUR)

Participants registered after 03.03.2017

non-IEEE Members - 500 RON (or 112 EUR) IEEE Members - 450 RON (or 100 EUR)

Students* registered by 03.03.2017

non-IEEE Student Members - 200 RON (or 45 EUR) IEEE Student Members - 150 RON (or 34 EUR)

Students* registered after 03.03.2017

non-IEEE Student Members - 250 RON (or 56 EUR) IEEE Student Members - 200 RON (or 45 EUR)

* Students must provide evidence of their afiliation, properly endorsed.

Accompanying Persons

100 RON (or 25 EUR), lunches on 23 and 24 March included 100 RON (or 25 EUR), get together party included

Additional Proceedings Volume

50 RON (or 12 EUR) / copy

Will you attend the get together party?

Yes No

Payment

Can be made either in RON or in EUR. We do not accept credit cards and checks.

Payment in RON || Beneficiary: ASOCIATIA „ALUMNI ELTH”, Bank Name: Banca Comerciala Romana, Agentia Politehnica, IBAN (RON currency): RO96RNCB0723126144180001, CUI: 29747552, Ref: ATEE 2017, Registrant’s name (participant’s name), Paper ID# Payment in EUR || Beneficiary: ASOCIATIA „ALUMNI ELTH”, Bank Name: Banca Comerciala Romana, Agentia Politehnica, IBAN (EUR currency): RO69RNCB0723126144180002, Bank Swift Code: RNCBROBU, Ref: ATEE 2017, Registrant’s name (participant’s name), Paper ID# On Site Payment

Invoice *

* If an invoice is requested, the applicant must provide the following information

Person

Please fill in the following: (1) Paper ID; (2) Family name and First name; (3) Personal numerical code (CNP); (4) Identification document (either Card of Identity or Passport)

Institution

Please fill in the following: (1) Paper ID; (2) Entity's name; (3) Unique identification code (CUI); (4) Delegate's name; (5) Delegate's Identification Document (either Card of Identity or Passport)