- SIC 2012 Registration Form –
First Name
Last Name
Name for Badge
Institution
Mailing Address
Postal Code
City
Country
Phone
Fax
Email
Have you submitted or plan to submit an abstract?
YES
NO
Accompanying Persons
Accompanying persons can participate in the field visits on October 9 and 12 and the
social programme (Welcome Cocktail on October 8, coffee breaks and the astronomical
observations with historical telescopes on October 10).
Note that if an accompanying person wishes to attend the sessions and receive the
Symposium materials, he/she must submit a registration form and pay the regular fee.
Number of accompanying persons
1. Full Name
2. Full Name
Regular and student fees cover attendance to the Symposium, Welcome Cocktail on
October 08, field visits on October 9 and 12, coffee breaks, the whole scientific and
social Programme, Book of Abstracts and the book “Images of Science: the MAST
collections”.
SIC 2012 – REGISTRATION FORM
SIC2012 Fee
In order to book accommodation, please contact hotels directly. You can find hotel
suggestions in the Symposium website (Travel & Accommodation Info).
CONFERENCE FEES
Until July 15
16 July - 31 August
Regular
USD130
USD160
From 01 September
until the Symposium
USD200
Student
USD80
USD100
USD120
Accompanying
Person
USD110
USD130
USD180
OPTIONAL ACTIVITIES
Conference dinner (October 11)
SIC2012
Total amount (Fee + Optional)
USD70
USD ...............................
Method of Payment
Bank
Transfer
Bank transfer costs should be paid by participants.
Please include your name and SIC2012 in the bank transfer
description.
Account holder: Associação dos Arquivistas Brasileiros
Bank: Itaú (code number : 341)
Agency Code: 0733
Account number: 01367-6
Swift code: ITAUBRSP
Cancellation requests received until July 31 will receive a full refund of registration fee.
Cancellation requests received between 01 and 31 August will receive a 40% refund. No
cancellation requests can be accepted after 1 September.
Questions ? Contact us by email at sic2012@mast.br
Signature:
Thank you for completing the SIC2012 Registration Form.
SIC 2012 – REGISTRATION FORM
Date:
Please print and fax (or digitalize and send by e-mail –
sic2012@mast.br) with:
a) copy of bank transfer receipt
b) copy of valid student ID card (if applicable)
to:
sic2012@mast.br or
Museu de Astronomia e Ciências Afins
C/o SIC2012
+55 21 35145214
Registration will not be processed without proof of payment.
SIC 2012 – REGISTRATION FORM