registration form

Participant data

*first name *last name title
*represented institution *department
*address
*zip code *city
-
country
*phone fax *e-mail
accompanying person

Before 1 April 2010: Abstract submission

I intend to present
to be included in the following session:
with the title:

Excursions

I'd like to participate in the 15 September excursion to Natural Park of Serra de Aire e Candeeiros:
I'd like to participate in the 17 September excursion to the Portuguese West Coast:

Payment information

 

Before 10 May

Between 11 Maio and 31 August

After 31 August
ALFA or AEFA associates 275€ 300€ 350€
Not associates of ALFA or AEFA 325€ 350€ 400€
Students 180€ 200€ 250€
Accompanying persons* 100€ 120€ 150€
*Includes excursion on the 15 September and the meeting closing dinner.

total amount Euros

Mode 1. Bank Transfer:

Account Holder: ADISA
Bank: Caixa Geral de Depósitos
NIB: 0035 0710 00001275330 30
IBAN: PT50 0035 0710 0000 1275 3303 0
BIC/SWIFT: CDGIPTPL

    Don't forget to:
  1. include your name on your bank transfer
  2. send the receipt for payment along with this Registration Form

please upload here the proof of transfer:

Mode 2: Check

Skip the check on behalf of ADISA and send by mail along with this Registration Form, to:
ADISA, Instituto Superior de Agronomia
Tapada da Ajuda
1349-017 Lisboa

Receipt information

name/ institution:
address:
zip code: -
fiscal number: