.: TNT2015 Conference :.

	TNT2015 registration Form
Toulouse (France) September 07 - 11, 2015


Registration Form Graphene Day

Gender (*)

Male Female

Title (*)

Mr./ Mrs./ Ms Dr./ Professor.

First Name (*)

Last Name (*)

Institution/Dep. (*)

Address (*)

City (*)

ZIP Code (*)

Country (*)

Phone (*)

Fax (*)

E-mail (*)

VAT (*)

TNT 2015 Fees

Graphene Day

180 Euros

TNT 2015 Conference Fee (5 days)

540 Euros

(*) Mandatory fields
(†) Justification signed by your PhD Adviser should be sent by e-mail (info@tntconf.org)

Additional Info

Arrival Date: September 2015 Departure Date September 2015

Accompanying Person Name
(restricted access - not participating in conference or exhibition)

Do you submit a contribution? Vegetarian?

P A Y M E N T (*)

(*) For Credit Card payment, a 2% (bank charges) will be applied.

1) Bank transfer to the order of "Fundacion Phantoms" must bear the mention "FREE OF CHARGE TO THE RECEIVER" and must indicate TNT2015 Conference and LAST and FIRST NAME of the participant to facilitate identification and to the following bank account:

    CaixaBank SA, Calle Ibiza 64, 28009 Madrid (Spain)
    BIC (Bank Identifier Code): CAIXESBBXXX
    IBAN (International Bank Account Number): ES55 2100 6441 5122 0002 0128
    Phantoms Foundation VAT Number: ES G83352724

PLEASE, SEND BY E-MAIL (info@tntconf.org) A COPY OF YOUR BANK TRANSFER MAKING CLEAR THE NAME OF PARTICIPANTS TO TNT2014 CONFERENCE.
ALL BANK CHARGES SHOULD BE PAID BY THE APPLICANTS.

2) Credit card [ VISA - MasterCard ] (*) For Credit Card payment, a 1,5% (bank costs) will be applied


To validate the Registration Form, please write the following code: