Confirmation on participation

For attantion of participants!

Those who wish to attend the conference should preferably fill the on-line registration form or alternatively download registration form, fill and send it by e-mail (as a scanned document) to the Organizing Committee, by September 1, 2011.

* Required fields

PARTICIPANT'S PERSONAL DATA

Family name*:       First name(s)*:

             Title*                                  Sex

Institution/Company*:

         Postal Address

                        ZIP:    City:    Country*:

Phone Fax: E-Mail*

ACCOMPANYING PERSON DATA

Family name: First name(s):

CONFERENCE REGISTRATION

Participants	Before Sep.1, 2011	After Sept.1, 2011
Full-meeting participant	200 EUR	250 EUR
Full-meeting participant (From Goergia)	30 GEL	50 GEL
Student (From Goergia)	10 GEL	15 GE
Accompanying person	50 EUR	50 EUR
Your payment

SOCIAL PROGRAMS

Conference Excursion	15 EUR
Conference Banquet	25 EUR
Your payment

HOTEL ACCOMMODATION:

Check in: Check out:

i.e. 2011-09-25 i.e. 2011-09-27

Note. Conference registration payment includes hotel fee for three days from September 25 till September 27.
The payment for additional days is 38 EUR/per day (for full participant) and 10 EUR/per day (for accompanying person).

Payment for aditional days:

Full-meeting participant
Accompanying person

Total*
(including converence registration, social activity, payment for additonal days)

PAYMENT:

Bank Account:

Customer Name: Association of Professional Chemists of Georgia
Account No: IBAN: GE42PC0503600100002119
SWIFT Code: MIBGGE22
Bank name: ProCredit Bank, Georgia
Bank Address: 154 Aghmashenebeli ave, 0112 Tbilisi, Georgia

PLEASE ENSURE THAT YOUR NAME IS INDICATED ON YOUR MONEY TRANSFER FORM