REGISTRATION FORM - NANOMATA 2009
International Symposium on Nano - Materials, Technology and Applications (NANOMATA 2009)
The College of Technology, Vietnam National University, Hanoi, Vietnam
15-17 October, 2009
Please return by fax to: + 84 4 3754 7460 or by post to: College of Technology, Vietnam National University, Hanoi – Building E3, 144 Xuan Thuy road, Cau Giay district, Hanoi , Vietnam (attention to Dr. Pham Duc Thang).
First name: ............................. Last name (family name): ................... Paper ID: ..... Institution/Company: ................................ ................................ ................................ ...................... Mailing address: ................................ ................................ ................................ ............................ City: ........................ State: .............. Postal code: ............. Country: .............
Phone: ................................ ...... Fax: ................................ . E-mail: .........................
Fees
(please tick appropriate)
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until 15 September 2009
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after 1 5 September 2009/on-site
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Workshop registration fee for participant (*)
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250 USD
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300 USD
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TOTAL
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USD
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USD
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(*) The fee includes admission to all conference sessions, a copy of the abstract book, publication charge, tea/coffee break refreshments and banquet.
(**) Social activities (tours to Hanoi city, surroundings and others) can be booked at the symposium site.
Vegetarian meals required? Yes No
Other important information: ................................ ................................ ................................ ..........
METHODS OF PAYMENT
By credit card
Card Holder’s Name (please print clearly): ................................ ................................ ................... Card number: ................................ ................................ .......Type (Visa/Master): ............... Issued by: ................................ ................................ ................................ ................................ ...... Expiry date: ................................ ................................ ................................ ................................ ....
By bank transfer (free of commission charges for the recipient) to the following bank account:
- Name of the bank: Stock Commercial Bank for Foreign Trade of Vietnam - Thang Long Branch
- Bank address: 98 Hoang Quoc Viet, Hanoi, Vietnam
- Account name (owner): TRUONG DAI HOC C ONG NGHE (College of Technology)
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Account number: 049.137.1614.933
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SWIFT code: BFTVVNVX 049
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Purpose of the payment:
NANOMATA 2009 – Name of participant(s)
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Date (dd/mm/yy): Signature:
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