ISINI 2018 CONFERENCE REGISTRATION FORM

    Wrocław, Poland, August 30-31. 2018

    (please send this form by e-mail to: This email address is being protected from spambots. You need JavaScript enabled to view it.)

    Surname: .......................................................................................................................................

    First name(s): ................................................................................................................................

    Prof/Dr/Mr/Mrs/Ms: ......................................................................................................................

    Position: ........................................................................................................................................

    Name of Organization: ..................................................................................................................

    Address: ........................................................................................................................................

    Post code/Zip code: .......................................................................................................................

    Country: ........................................................................................................................................

    VAT/TAX number: .......................................................................................................................

    Tel: ................................................................................................................................................

    E-mail: ...........................................................................................................................................

    Accompanying Delegate: ..............................................................................................................

    Surname: .......................................................................................................................................

    First name(s): ................................................................................................................................

    Prof/Dr/Mr/Mrs/Ms: ......................................................................................................................

    Dietary requirements: ....................................................................................................................

    Registration Fee per delegate

    Full registration €175 (PLN 700)

    Accompanying delegate €100 (PLN 400)

    Please note that registration fee is non-refundable. After the payment an invoice will be send by email. The registration is final after payment.

    Payment in Euro to the following account:

    Account holder: Wyższa Szkoła Bankowa we Wrocławiu

    Bank Zachodni WBK S.A. 25 we Wrocławiu, Ul. Gubińska 17, 54-434 Wrocław

    SWIFT: WBKPPLPP

    IBAN: PL 55 1090 2402 0000 0001 1479 5322

    Title: ISINI 2018 + name of participant

    Payment in PLN to the following account:

    Bank Zachodni WBK S.A.  80 1090 2402 0000 0006 1001 1591

    Title: ISINI 2018 + name of participant

    Date, Name: ..................................................................................................................................

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