ONLINE COURSE APPLICATION

 

COURSE INFORMATION

 

LOCATION                                                                                                                                                                                  

 

The University of the Basque Country. Faculty of Chemistry. 

P. Manuel de Lardizabal, 3   E-20018 Donostia-San Sebastian, Spain

September 11-15, 2006

 

PERSONAL INFORMATION                                                                                                                                                

 

Name:

                          First                                     Initial                         Last       

Organization /Institution

Address

City

Country

Postal Code

Phone     Fax Ex: 34-943-018000. Include extension if applicable. Please use hyphens only, no"+" or "()" characters.

E-mail

 

PROFESIONAL INFORMATION                                                                                                                                       

 

         

                                 

ACCOMMODATION RESERVATION (deadline for submitting reservations to the Hotel/Residence June 30, 2006).                                                                            

 

The availability and price of these rooms are guaranteed until June 30, 2006. In all cases, you must arrange your reservation directly providing the "EMULSION COURSE" reference.

                             NH-Aranzazu****                              Barcelo Costa Vasca****           Olarain Residence 

The payment for hotel or residence rooms must be done directly with the Hotels/Residence, that will provide you an invoice.
 
FEES
Registration € 1,100              
Method of Payment

Bank Transfer to “POLYMAT-Ingenieria Instituto Materiales Polimericos”. (Free of  transfer charges). Bank: Caja de Ahorros y Monte de Piedad de Guipuzcoa y de San Sebastian "KUTXA", Plaza Benta Berri s/n, 20009 Donostia-San Sebastian, Spain.

IBAN: ES 40 2101 0381 06 0010126845                     SWIFT Code: CGGKES22                        Please reference full name of your company and fax a copy of the bank transfer paper to us

Check payable to “POLYMAT-Ingenieria Instituto Materiales Polimericos”

Payment by credit card cannot be arranged.

 

SUBMITTING THE REGISTRATION FORM
By clicking the SUBMIT button, you send the above information