I C O N 2006 - Venezuela

Organised by:

Sponsored by:

ICON2006 - International Conference on Nanoscience
Choroní (Venezuela) 07 - 11 May, 2006

Registration Form

The registration form could also be sent by fax (+34 91 4973471)

Gender(*)	Male Female
Title(*)	Mr./ Mrs./ Ms Dr./ Professor.
First Name(*)
Last Name(*)
Institution/Dept.(*)
Address(*)
City(*)
*ZIP Code()**
Country(*)
Phone(*)
Fax(*)
E-Mail(*)

Doctoral Student (*)

ICON2006 Fees

Limited number of single rooms (20) are available for ICON2006 - allocated on the basis first come / first served.

Before April 14

After April 14

Regular Fee (Single Room)

700 Euros

775 Euros

Regular Fee (Double Room)

600 Euros

675 Euros

Regular Fee (with Companion)

600 Euros
+ 325 Euros
Total: 925 Euros

675 Euros
+ 400 Euros
Total: 1075 Euros

Before April 10

After April 10

Student Fee* (Double Room)

500 Euros

575 Euros

Student Fee* (Triple Room)

450 Euros

525 Euros

Student Fee* (QuadrupleRoom)

350 Euros

425 Euros

Student Fee* (with companion)

500 Euros
+ 325 Euros
Total: 825 Euros

575 Euros
+ 400 Euros
Total: 975 Euros

(*)Justification signed by your PhD Adviser should be sent by FAX (+34 91 497 34 71) or e-mail (icon2006@phantomsnet.net)

Additional Info

Companion Name

Shuttle Bus

Do you submit a contribution?

Vegetarian?

P A Y M E N T

(*)

1) Bank transfer to the order of "Fundacion PHANTOMS" must bear the mention "FREE OF CHARGE TO THE RECEIVER" and must indicate ICON2006 Conference and LAST and FIRST NAME of the participant to facilitate identification and to the following bank account:

VAT Number: ES-G83352724
    CAJA MADRID – Pabellon C – PCM, 28049 Cantoblanco (Madrid) – Spain
    I.B.A.N (International Bank Account Number): ES15 2038 1608 7060 0001 1588
    BIC (Bank Identifier Code): CAHMESMMXXX

PLEASE, SEND BY FAX (+34 91 4973471) A COPY OF YOUR BANK TRANSFER MAKING CLEAR THE NAME OF PARTICIPANTS TO ICON2006 CONFERENCE.
ALL BANK CHARGES SHOULD BE PAID BY THE APPLICANTS.

2) Cheque to the order of "Fundacion PHANTOMS"

Cheques should be sent to the following address:

Dr. Antonio CORREIA - ICON2006 REGISTRATION

Fundacion PHANTOMS, PCM - Pabellon C, 1ª Planta. Campus de Cantoblanco - UAM. Ctra. Colmenar Viejo km 15, 28049 (Madrid), Spain

3) Credit card [ American Express - VISA - MasterCard ]

Card Number		Valid
		/


American Express	VISA	MasterCard

CANCELLATION OF CONFERENCE PARTICIPATION
All cancellations should be made in writing by fax (+34 914973471) or e-mail to Antonio Correia (antonio@phantomsnet.net).
Your payment less 50 Euros will be reimbursed, if a cancellation is received between March 01 and April 15, 2006
50% of the registration fee will be reimbursed, if a cancellation is received between April 16 and May 01, 2006
No reimbursement will be made after May 01, 2006

INSURANCE
The Organisation Committee will not be responsible for any medical expenses, lost property, or accidents during the ICON2006 conference and we strongly recommend that participants make all necessary insurance arrangements for themselves.