Registration Form COFRET ` 10

COFRET ' 10
The 5th Francophone Colloquium in Energy,
Environment, Economy and Thermodynamics
5 - 7 May 2010, Iași, Romania
Registration Form
Please fill-in this form, print it, SIGN it, SCAN it and send the scanned copy by e-mail to
the Conference Secretariat before April 15.
Should you have any questions, please do not hesitate to contact us.
E-mail:
[email protected]
[email protected]
Personal information (Please type or print clearly in CAPITAL LETTERS)
*all fields marked with a star are required for registration
*Title:
Mr.
Mrs.
*Function at conference:
*First (Given) name:
Ms.
Prof.
Dr.
Presenting author
Other
(Please specify)
Attending author
*Middle name:
Invited speaker
Student
*Last (Family) name:
*Name for badge: (if your preference is different from the names above)
*Affiliation: (University / Institution / Organization)
Postal address:
Postal / Zip code:
*City:
*Country:
*Telephone: (country code - area code - tel no.)
*Fax: (country code - area code - fax no.)
*E-mail address:
Accompanying person (Please type or print clearly in CAPITAL LETTERS)
IMPORTANT: If you have more than one accompanying person, please contact the Conference Organizing Committee
*Title:
*First (Given) name:
*Last (Family) name:
*The accompanying person will participate at:
Gala Dinner - 30 EUR
Cotnari trip - 35 EUR
Monasteries tour - 65 EUR
Travel details: (if known)
Arrive by
Date
Time
Depart by
Date
Time
Hotel reservations:
Should conference organizers make accommodation arrangements in your name?
(starting with your arrival
date specified above)
Yes
No
(informative price per night)
Hotel Traian
(4*)
Number of nights
Room type
Hotel Traian
(3*)
Number of nights
Room type
Hotel Astoria
(3*)
Number of nights
Room type
The above mentioned hotels are the recommended Conference Hotels. Given the location of conference meetings
(downtown), there are many other accommodation opportunities nearby. Here are some suggestions:
Hotel Unirea (3*)
Pensiunea Ambiance City (3*)
Hotel Studis (3*)
http://www.hotelunirea.ro/
http://www.ambianceiasi.ro/
[email protected]
Prices from 55 EUR to 100 EUR
Prices from 45 EUR to 55 EUR
Prices from 20 EUR (two-room apartments)
There are some low-cost accommodations available for students in Tudor Vladimirescu campus (about 3 km from
downtown) in T23 (3*) and T20 (1*) student halls. Please contact conference organizers for more information.
Payment information:
Payment should be made by Bank transfer (a copy MUST be sent to our office for payment identification)
Name:
Address:
Universitatea Tehnica "Gheorghe Asachi" din Iasi - UTIVP
Bd. Dimitrie Mangeron nr. 67
Iasi, 700050, Romania
Payments in RON:
Trezoreria Iasi
IBAN:
RO12 TREZ 4065 0460 1X00 0731
Cod Fiscal: 4701606
Pentru:
COFRET 2010
Payments in EUR:
BRD Iasi
St. Anastasie Panu 1B-2A
IBAN:
RO30 BRDE 240SV 1162966 2400
SWIFT:
BRDEROBU
Beneficiary: COFRET 2010 Conference
Important information:
All delegates, whether presenting or attending only, are subject to the registration fee - 200 EURO.
This fee includes: coffee-breaks, lunches (restaurant), gala dinner, bag, badge, program, a copy of conference
proceedings, and participation at conference events. The accompanying person will receive a badge, and will
participate at the conference events that you selected above and paid for in advance.
An e-mail message confirming receipt of payment will be sent to the address provided above. Please bring the
confirmation message with you to the registration desk to facilitate the registration process. Conference materials will
not be provided without payment of the registration fee. No refund will be granted for no-show.
Privacy clause: The information you provided on this form will be used for the sole purpose of processing your
enrolment for the 2010 COFRET Conference and printing of the conference directory. The information provided will
not be made available for any other purpose.
*Signature
Date