2012 IEEE International Conference on Industrial Technology (ICIT 2012)
EMAIL TO:
icit2012@meetingplanner.gr
Title:
Prof.
Dr.
Early-Registration Deadline
REGISTRATION FORM
Mr.
December 31st, 2011
Mrs.
First Name:
Middle Initial:
Last/Family Name:
Company/Institution:
Address:
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Country:
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E-mail:
IEEE Membership #:
Tel: +
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Area Code
Fax: +
Number
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Area Code
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Please let us know if you have any disability and/or any special dietary requirements:
REGISTRATION FEES (At least one author of each paper must register using one of the first 3 categories below, by December 31st, 2011)
All Fees are in Euro (€) and all taxes are included
Early, by Dec. 31st , 2011
Category
Late, or on-site
Registration Amount
IES Members
450,00
540,00
IEEE Members
470,00
564,00
Non-IEEE Members
564,00
676,80
Student IEEE Members
282,00
338,40
Student Non-IEEE Members
338,40
406,08
Life Members
329,00
394,80
All above types of registration include: Admission to all conference sessions, Conference proceedings, Coffee breaks,
3 lunches (Mon. to Wed.), Welcome reception, Conference dinner. Papers can only be registered through the
categories: IES Members, IEEE Members and Non-IEEE Members. These registration fees cover the registration of 2
papers (6 pages each). Registered papers which will be presented at the Conference will be included in the
proceedings.
ADDITIONAL ITEMS
Quantity
Amount
Additional Proceedings
25,00
Additional Welcome Reception Ticket
50,00
Additional Banquet Ticket
75,00
Additional 3-Day Luncheon Ticket
90,00
Additional pages (after the 6th for each paper)
50,00
Additional paper(s) (after the second paper)
282,00
Total Amount for Additional Items:
Subtotal
Please indicate your paper number(s).
For more than 2 papers, there is a charge of
€ 282,00 for each additional paper.
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€
CANCELLATION AND REFUND POLICY: Before February 17, 2012: 100% refund less € 100,00 administration fee. No refunds after February 17, 2012.
Please check.
I have read and accepted the cancellation terms mentioned above and on the ICIT 2012 website.
METHOD OF PAYMENT – CHECK ONE ONLY
By Bank Transfer (Please add EURO 20,00, as handling fee. The total must be net of all bank expenses)
Email (icit2012@meetingplanner.gr) this form and you will be sent an e-mail with the necessary bank account details. Please provide us with a valid
email address.
By Credit Card. Please circle one: MasterCard / VISA
I authorize you to charge my credit card with the amount of Euro:
Card Number:
Expiry Date:
Cardholder’s Name (In case the registrant is not the card holder, please email also a copy of both sides of the credit card):
ID validation number (The last 3 digits of the number that can be found on the back side of your credit card) :
Cardholder’s Signature:
Date:
ICIT 2012 Registration Desk
Tel: +30-2610-992025
e-mail: icit2012@meetingplanner.gr