LTC Conference Registration Form

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Personal data

First Name *

Surname *

Affiliation *

Address *

E-mail *

Telephone *

Mobile *

Are you a student? *

Yes

Payment

Payment has been done on (date): *

YYYY

Payment method: *

credit card

bank transfer

cash on site

Payment amount: *

List of papers related to this registration (if applicable):

ID of Paper 1

(if applicable):

Title of Paper 1

(if applicable):

Does Paper 1 have additional page?

(if applicable) / remember to cover extra fee (20 euro)

Yes

Clear selection

ID of Paper 2

(if applicable) / remember to cover the additional paper fee (120 euro)

Title of Paper 2

(if applicable) / remember to cover the additional paper fee (120 euro)

Does Paper 2 have additional page?

(if applicable) / remember to cover extra fee (20 euro)

Yes

Clear selection

ID of Paper 3

(if applicable) / remember to cover the additional paper fee (120 euro)

Title of Paper 3

(if applicable) / remember to cover the additional paper fee (120 euro)

Does Paper 3 have additional page?

(if applicable) / remember to cover extra fee (20 euro)

Yes

Clear selection

Is your paper eligible for "The best student paper" contest?

Yes

Clear selection

Have you submited materials for LREMAP?

Yes

Clear selection

Accompanying person(s)

(if applicable)

Accompanying person(s) Name(s) and surname(s):

(leave empty if not applicable)

Does the accompanying person(s) intend to participate in the banquet (November 26)?

(Additional fee will be charged on site.)

Yes

Clear selection

Invoice and additional information

Information necessary to issue the invoice *

(name, address, VAT number /if applicable/, NIP /if applicable/)

Remarks/Additional information

Submit

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