Agile Portugal

Registrations are closed.

In case you have difficulties in completing the application form please contact us via email: chairs@agilept.org

Fields marked with * are mandatory

1. Personal Information

Full Name *

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

Address *

Postal/Zip Code *

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 *

(Please insert your email address. The address introduced will be used for future communications)

2. Invoice Information

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

Receipt in

Name

Address

Postal/Zip Code

City

Country

TAX Number

Phone Number

Fax

3. Registration - Conference fees

Role:

Price

Friday 6th - Conference day

(Participants only - just check this if you're a participant and you'll be going on Friday...no need to check if you're a speaker, sponsor or staff...)

None

Saturday 7th - Workshops

(Select which one you'll attend on Saturday)

None

TOTAL: 0.00 €

4. Payment Method

Not applicable

Credit Card

Morada IPLeiria:

Instituto Polit�cnico de Leiria

Rua General Norton de Matos

Apartado 4133

2411-901 Leiria

Portugal

Pol�tica de Privacidade | Pol�tica de Reembolso

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

ATM Reference (Entity and Reference)

ATM payment only available for participants with Portuguese national bank account

5. Submit Registration

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