DoCEIS'11

Registration Form

PARTICIPANT INFORMATION (also to be included in conference badge)

First Name: Last Name:

Organization:

Country:

Phone: Fax:

Email:

Registration Fee

Socolnet Member	270€
IEEE-IES Member	270€
IFIP	270€
UNL-FCT / UNINOVA Student	270€
IEEE-Member	285€
Non-Member	300€

Membership/ID Number:

Attention! For authors: Each registration fee is attached to a maximum of ONE paper.
Paper ID attached to this registration

BILING INFORMATION

Organization/Name:

Country:

Mailing Address:
Line #1
Line #2
Zip Code

Phone: Fax:

Email:

VAT Number: (if applicable)

Payment shall be made in EUROS(€) by Credit Card:

Credit Card Holder Name:
Credit Card Number:
Exp. Date (mm/yy): CVV2/CVC2: (1)
Credit Card Signature:

Submit procedure can take a few seconds. Please, press the submit button only once!

If you have problems with the on-line registration system generating the PDF registration form, you can use this blank form. Please, print it, fill it, and send it by FAX to the DoCEIS'11 Secretariat: +351 21 294 85 32.

(1) Card Verification Value or Code
http://en.wikipedia.org/wiki/Card_Security_Code