The College of Technology, Vietnam National University, Hanoi, Vietnam



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loạiRegistration form
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)

until 15 September 2009

after 1 5 September 2009/on-site

Workshop registration fee for participant (*)

250 USD

300 USD

TOTAL

USD

USD

(*) 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)



................................................................................................ ......................... ...................



Date (dd/mm/yy): Signature:
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