Print this page and send it by fax to: +351 239 704 691

EuroLogo'2003 - Registration
 
Personal Information
Name: ______________________________________________
 
Address: ______________________________________________
______________________________________________
______________________________________________
 
Country: ______________________________________________
 
Email: ______________________________________________
 
Type of Registration Normal  Student
 
Discovery Day I wish to participate on the Discovery Day.
 
  Number of accompanying persons:_________
 
Payment

Check 
send the check in registered letter to:
Cnotinfor
Trav. Av. Mendes Silva
Edifícios Vale Flor, nº.39 escritório i
3030-199 Coimbra
Portugal
(if you are outside Portugal, send an international check)

VISA Credit Card
Name: _____________________________
Number: ____-____-____-____  ___ (c.v.v.*)
Expiration Date: __ /_____
* c.v.v. = last 3 digits of the secutity code on the back of the card, within the signiture space
 

Bank Transference

Use the following bank account:
Bank: BNC - Banco Nacional de Crédito
IBAN: PT50 0046 0223 1383 6100 17746
NIB: 0046 0223 1383 6100 17746

Note: Use IBAN, if you are making an international bank transference. Use NIB, if you are making a national bank transference.