Registration Form
 

Please complete the form and press the SUBMIT button. A confirmation e-mail will be then sent to you. All fields marked by an asterisk (*) must be filled in.

PERSONAL INFORMATION:
Title
First Name*
Surname*
Affiliation*
Postal Address*
Code/City*  /
Country*
Affiliation for badge*
(in Eng)
E-mail*
Phone
Fax
NIP instytucji delegujacej
( for Polish participants only )
  Vegetarian diet
PAYMENT INFORMATION:
REGISTRATION FEE:
 regular (early / late) (650 / 850 PLN)
 student's (early / late)
(for participants who on day of their registration
are less than 27 years old)		 (450 / 550 PLN)
 
PRACE project only  REGISTRATION FEE: (200 PLN)
 
ViroLab project only  REGISTRATION FEE: (320 PLN)
 
ADDITIONAL PAYMENT
  Workshop dinner for an accompanying person (150 PLN)
-----------------
TOTAL PAYMENT (PLN):   
early / late — before / after September 26, 2009
PAYMENT METHOD:

credit card
bank transfer to the account:
Accountholder:
Bank:		 ACK CYFRONET AGH
Pekao SA
ul. Pijarska 1, 31-015 Krakow, Poland
Account No:
SWIFT:
Transfer Name:		 PL 11 1240 4722 1111 0000 4849 0168
PKOPPLPW
CGW09

Bank charges are to be covered by the payer.
Please mention clearly your name on the payment order.

Please check carefully the information you entered.
Click on SUBMIT to proceed with your registration. Click on RESET to clear the form and start again.