4ICMCTA Palmela 2014
Registration form
To register in 4ICMCTA please fill out the following form.
Title
First name *
Your answer
Last name *
Your answer
Organisation *
Your answer
Position
Your answer
City *
Your answer
Address *
Your answer
Zip Code *
Your answer
Country *
Your answer
E-mail *
Your answer
Telephone
Your answer
Fax
Your answer
Name badge
Please indicate your name badge at conference if different from above (first and last name)
Your answer
Receipt Information
In case you would like different address information to be printed in the conference receipt, please fill out the following fields. This information cannot be changed after the receipt has been issued.
Affiliation or Name
Your answer
Adress
Your answer
Zip Code
Your answer
City
Your answer
Country
Your answer
VAT Number *
(if not applicable, please insert 0123456)
Your answer
Paper Information
If you have 4ICMCTA accepted paper(s), please fill out your paper(s) number(s), otherwise you will not be able to submit the final version of your paper(s).
Paper(s) number(s)
Your answer
Food restrictions
Food restrictions
Your answer
Conference registration
(to register as a student you will have to submit proof of your current student status, which must be sent to icmcta@ua.pt) *
Standard – 450 euros
Student - 340 euros
After 20th July 2014
Accompanying Person(s)
Nr of accompanying person(s)
Your answer
Total number of meals on the Castle (25 euros / meal)
Your answer
Social Program + Gala Dinner + Transportation (70 euros / accompanying person)
(please insert the number of interested accompanying persons)
Your answer
Cost Meeting
A COST Meeting on Random Network Coding and Designs over GF(q) - IC1104 - is going to be held in the Castle of Palmela on 17-19 September 2014. If you wish to attend Cost Meeting and you are not a member of the Cost Action IC1104, please select the following item.
Cost meeting attendance
Free Shuttle Bus
If you need transportation between Setúbal and Palmela Castle during the conference and/or meeting, please choose one of the following pick-up points.
Pick up points (in Setúbal)
Payment
The payment will be made by bank transfer to:

UNIVERSIDADE AVEIRO;
· Fiscal Identification Number: 501461108
· Account number: 0836000022430 EUR
· NIB 0035 0836 00000022430 30
· IBAN PT50 0035 0836 00000022430 30 --- BIC SWIFT CGDIPTPL

When sending a bank transfer please send a remittance advice to the conference organisation via email at icmcta@ua.pt or by fax +351 234370066, mentioning your full name and the reference 4ICMCTA.

All bank fee must be cover by the participants
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