Registration Form

Personal Information | Home Institute | Payment

I will participate in the school as a:

Speaker
Other

Do you intend to present a poster?

Yes
No

Are you going to attend the Tutorials?

Yes
No


Personal Information


Title
Last Name
First Name
CPF or Passport Number
E-mail

Physicist Computer Scientist Electronic Engineer Others


Home Institute


Institution
Address
Country
State
City
ZIP Code
Phone (Country code + area code + number)
Fax
Additional Information
(questions, comments, etc)


Payment


The registration fee covers:
Conference attendance
Conference material
Conference tour
Banquet
Payment of Registration Fee:

Cash upon arrival (US$ 400.00) (NO TRAVELLER CHECKS)
Direct deposit to our account (US$ 350.00) (after January 10th: US$ 400.00) 
   Make a deposit to the following account and FAX a copy of the 
   deposit receipt to the School Secretariat.


      Wire Transfer To: 
	Citibank N A - New York
	Swift Code: CITIBRBR 
	ABA: 021000089 
	DDA: 36125649
      To Credit: 
	Citibank/Rio de Janeiro/Brasil 
	Rua da Assembléia 100
	Swift Code: CITIBRSPRJO
      In Favor of: 
	ASSOCIAÇÃO INTERNACIONAL DOS AMIGOS DA FÍSICA EXP DE ALTAS ENERGIAS  
	C/C 75001586


   Secretariat FAX: 55-21-25877454
HOTEL RESERVATION!
 
Be aware you must make yourself the hotel reservation! Please,
visit the Hotel Reservation page for more details.



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