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PERSONAL INFORMATION
Mrs Prof Mr Dr
Surname (as it should appear on the badge and lists) First name (as it should appear on the badge and lists)
Institution / Company Address
City Zip code
Telephone: Country
Are you applying for financial support?   Yes       No
Citizenship:
Institutional e-mail: Alternative e-mail:

Do you need an invitation letter for VISA? Yes       No
> Visa requirements <

Abstract title (150 characters maximum)
Author(s) full name, Institution, Country (in the order that appear in the abstract submission)
Gender Male       Female
Date of birth (DD/MM/YY)
Passport number
Assistance for travel Yes       No
Assistance for daily subsistence allowance (DSA) requested Yes       No
Lenght of stay
Please indicate estimated dates of arrival (DD/MM/YY) and day of departure
Student       Early Career Scientist
If your are student, please indicate the degree and expected year of completion. If you are Early Career Scientist please indicate the graduation date and current research interests.
   
Please provide briefly your motivation to attend this Conference (150 words maximum)
   
Please provide a short CV (150 words maximum)  



REGISTRATION COSTS AND PAYMENT METHOD
Category 15/01/2014 - 31/01/2014
US$
01/02/2014
US$
Regular 275 375
Student 175 275

Conference Dinner (US$ 50) Yes        No
  Total: US$ 0


Fees for all Congress Participants include
  • Participation in all Scientific Sessions
  • Congress materials
  • Coffee breaks

Student discount
To qualify for the discounted rate, a student must be currently pursuing MSc or PhD in a conference relevant degree program. In order to prove her/his status, the student must send a copy of his student ID and/or a proof of enrollment by e-mail to: 2014wcrp@gmail.com



Credit Card - Paypal
 
Do you want to pay now?
Do you want to pay later? Instructions to pay in e-mail confirmation of your registration.

If the cardholder does not match that of the registration, please inform us via e-mail:
2014wcrp@gmail.com.
Bank Transfer
  Details for payment by Bank Transfer are:

Account Holder: Marcelo Barreiro
Bank: Banco República
SWIFT Code: BROUUYMM
Bank Address: Bolonia s/n y Av. Italia Account No: 157 0246760
Agency: Portones
Postal Code 11400

Please indicate on the payment reference the name of the payee and purpose: WCRP LAC and your full name.

With respect to bank transfers, all bank charges must be covered by the payee. Please make sure to indicate on your payment instructions to your bank that "All costs borne by ordering customer". An email confirmation will be sent once the payment has been received.