VRAP - Advanced Research in Virtual and Rapid Prototyping 2013

Registrations are closed.

In case you have difficulties in completing the application form please contact us via email: Mauro Sousa (mauro.sousa@ipleiria.pt) or Margarida Filipe (margarida.filipe@ipleiria.pt)

Fields marked with * are mandatory

1. Personal Information

Full Name *

(Please insert your full name according to your identification card.)

Address *

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City *

Phone Number *

TAX Number *

Country *

Affiliation *

(Please enter the designation of the company or institution where you develop your professional activity.)

E-mail address *

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Birth date *

Academic degree *

Area *

2. Invoice Information

Please fill in the fields below if you require the invoice in a different name from above-mentioned.

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Name

Address

Postal/Zip Code

City

Country

TAX Number

Phone Number

Fax

3. Registration - Conference fees

Price

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4. Payment Method

Credit Card

???label.address.ipleiria??? IPLeiria:

Instituto Polit�cnico de Leiria

Rua General Norton de Matos

Apartado 4133

2411-901 Leiria

Portugal

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Note: After you select the credit card payment method and submit the application form, you will receive an email for credit card payment instructions.

Bank Transfer

Payment by Bank Transfer to:
Instituto Politécnico de Leiria
R. General Norton de Matos
Apartado 4133
2411-901 Leiria

Bank Name:
Instituto de Gestão da tesouraria e do Crédito Publico, IP
Avenida da República, N.º 57, 6º
Place: Lisboa
Postal/Zip Code: 1050-189
Country: Portugal
NIF: 503 756 237
Phone: +351 217 923 300
FAX: +351 217 993 795

NIB: 078101120000000133640
IBAN: PT50078101120000000133640
SWIFT BIC CODE: IGCPPTPL

For bank transfers, the description of the transfer must comply with the following format: "VRAP2013+Registration Number".

A copy of the payment/transfer should be sent by e‐mail to the Secretariat member of the Conference Organizing Committee - Mauro Sousa (mauro.sousa@ipleiria.pt) or Margarida Filipe (margarida.filipe@ipleiria.pt).

5. Submit Registration

I read and understood the regulations and I declare that I agree with all its terms and conditions. *

I declare that all informations provided on this Application Form are true without any omission to the same. *

I don't give my image's rights for the purpose of publicizing and promoting the IPL's activity.