8thChaotic Modeling and Simulation International Conference
Henri Poincaré Institute, Paris, France, 26 - 29May2015
REGISTRATION FORM
PERSONAL INFORMATION
Title:□ Prof□ Dr□ Mr□ Mrs□ Ms
Family name: ……………………………………………First name(s): …………………………………………………….
Affiliation: …………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………
Address: …………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………
City: ……………………………………Area code: ……………………Country: ……………………………………....
Tel: …………………………………Fax: ……………………e-mail: ……………………………………......
Accompanying Person(s):
Family name: ……………………………………………First name(s): …………………………………………………….
Family name: ……………………………………………First name(s): …………………………………………………….
Abstract/Paper Title: ………………………………………………………………………………………………………………
Author(s): …………………………………………………………………………………………………………………………..
Social Programme / Before March 30 / BeforeApril 30 / After 1st of May / No of Persons / Total
□ Welcome Reception (Tuesday May 26) / Free / Free / Free / □
□ Half-Day Excursion (Wednesday May 27) / 50 € / 55 € / 60 € / □
□ Conference Dinner (Thursday May 28) and lunches / 75 € / 80 € / 85 € / □
□ Full-day Excursion (Saturday May 30) / 80 € / 85 € / 90 € / □
Total
Registration fees / Before
March 30 / Before
April 30 / After 1st of May / Total
□University member registration1 / 360 € / 420 € / 460 €
□Other Participant registration1 / 450 € / 490 € / 520 €
□Student submitting a paper registration1 / 280 € / 320 € / 360 €
□Student registration1 / 180 € / 200 € / 220 €
□Accompanying person(s)2 / 180 € / 200 € / 220 €
□Day registration(s)3 / 250 € / 280 € / 300 €
Social Programme: Sub-Total
Total
1Registration fee includes: Admission to all sessions, conference bag with book of abstracts, full paper publication, coffee breaks, and welcome reception.
2Registration fee includes: Welcome reception, coffee breaks, conference dinner, lunches and the excursions.
3Day registration fee includes: Attendance at that day's Conference sessions, Conference bag with book of abstracts, full paper publication and coffee breaks.
METHOD OF PAYMENT
Please indicate the preferred method of payment:by Bank Transfer or by Credit Card
Give your VAT No (if any): …………………….
□ Bank Transfer:To: ISAST International Society
Account number: 101 00 2002264027
IBAN number: GR49 0140 1010 1010 02002264027
BIC: CRBAGRAA
Bank details: ALPHA BANK
Address: 40 Stadiou Str, Athens10252, GREECE
Refer the CHAOS2015 Conference in the bank receipt. After the bank transfer, please state clearly the “Participant name” and send a copy of the bank receipt by e-mail to:
□Credit Card:
□VISA□MASTERCARD□AMERICAN EXPRESS
Cardholder’s name: ……………………………………………………………………………………
Card number: ………………………………………….. Expiration date: ……………………………
Cardholder Verification Value (last 3 digits at the back of the card or 4 digits at the front of AMEX cards) ….…
Confirmation
A letter of confirmation will be sent by e-mail to each participant as soon as the registration form and payment are received by the conference secretariat.
Receipts will be issued during the conference.
In case of bank transfer, a confirmation letter will be sent only after the bank receipt is received by the conference secretariat.
Cancellation of registration and refunds
By 15 April 2015Full refund minus 35 € as a handling fee
By 1 May 201560% of the registration fee will be refunded
After 1 May 2015No refund
The conference secretariat must be notified in writing (Email) of cancellation of registration. The appropriate refunds will be made available after the conference.
Alterations
Alterations to your registration will not be accepted over the telephone. Please e-mail any changes to the conference secretariat.
Date: ………………………………………… Name and/or Signature: ………………………………………….
Please complete this form in capital letters and return by e-mail to: Chaos2015 International Conference
E-mail: