REGISTRATION FORM

PERSONAL DATA (* Mandatory fields)

First Name*		Surname*

Institution*		Position

Address


Post code		City*

Country*

Phone*

E-mail*

Special food needs (intolerances, vegetarian)

Comments / Remarks

Are you speaker/author? YES NO

Paper Title

Paper Authors

BILLING DATA (to fill ONLY if an invoice is requested. A receipt will be sent to all registrants together with the registration confirmation). A pro-forma invoice will be sent by e-mail if you request an invoice. The final invoice will be presented when you register at the Secretariat Desk.

Institution (First Name and Surname if the invoice must be issued to yourself)


VAT Identification Number

Address		Post code

City		Country

REGISTRATION FEES (21% VAT included)

		Before 20 May, 2013	After 20 May, 2013
	General fee*	660 €	760 €

*The registration fee includes: access to all scientific sessions, documentation, daily lunches, refreshment breaks and conference dinner.

PAYMENT METHOD

Bank transfer

Bank name: Caixa d’Estalvis i Pensions de Barcelona “la Caixa”
Account name: ACTIVA CONGRESOS–CLRC 2013
Account number for national transfers: 2100 5633 25 02 00050757
Account number for international transfers: IBAN ES85 2100 5633 2502 0005 0757

BIC/SWIFT code: CAIXESBBXXX
(It’s mandatory to state the participant’s name in the bank transfer concept)

Credit card

Please note that cards accepted are VISA, MASTERCARD & EUROCARD.

Once you submit this registration form, you will be automatically redirected to the online payment system.

Early fees are only applicable if the registration form and payment are received before 20 May, 2013.

Your registration will only be accepted after payment has been received.

CANCELLATIONS

Cancellations must be made in writing to Activa Congresos. The corresponding refunds will be made after the Conference celebration. Applicable conditions are:

For cancellations received by 20 May, 2013, any money you have paid will be refunded, less 50 € administration charge. Thereafter no refunds can be made for cancellations or failure to attend. Substitutions may be made at any time, but please inform Activa Congresos in writing.

PROFESSIONAL DATA

We inform you that the professional data given in this form will appear in the conference participant list. Please, if you do not want to appear in the list, inform Activa Congresos in writing.

TOTAL AMOUNT TO BE PAID: 0 €

Activa Congresos
Passeig de l’Havana, 11-13, A1, 2º 2ª
08030 Barcelona
Phone (34) 93 3238573
E-mail: olga@activacongresos.com
http://www.tsc.upc.edu/clrc/

ACTIVA CONGRESOS, S.L informs you that all your personal data collected by the fulfillment of this document will be stored in an automated processing file of our property registered in the General Record Department of the Spanish Data Protection Agency. All your personal data will be processed with the maximum confidentiality, according to the Privacy and Security Policy of this company, and with total compliance to the Personal Data Protection Law 15/1999, of 13 December. The purpose of this data treatment is to manage your registration to the 17th Coherent Laser Radar Conference (CLRC 2013). The addressees of the provided information are Activa Congresos S.L. and UPC.

By the fulfillment of this document, you allow us to store your personal data for an automated and documentary treatment as expressed above.

We also inform to you, as owner of the personal data, that you can exercise your rights to opposition, access, rectification and cancellation of your personal data, sending your request with an ID copy at the following address: ACTIVA CONGRESOS, S.L, Pg. de l’Havana, 11-13, A1, 2º 2ª, 08030 Barcelona. You can also exercise such rights by sending an e-mail to the following address: activa@activacongresos.com