Institute of Biopolymers and Chemical Fibres, M.Sklodowskiej-Curie 19/27 90-570 Lodz, Poland tel.: +48 42 6376744, fax +48 42 6376214 4th EPNOE International Polysaccharide Conference Warsaw, 19-22 October, 2015 Registration form First name: * Last name: * Academic degree: Position: Institute/Company name: Street name: Street number: Postal code: City: Country: Phone number: E-mail: oral poster without presentation Invoice data: Institute/Company name: * Street name: * Street number: * Postal code: * City : * Country: * Tax number Valid VAT identification* number should be entered (if applicable) * obligatory fields I herewith express my consent for the processing of my personal data information exclusively for the organizational and promotional purposes of the conference: „4th EPNOE International Polysaccharide Conference. Conference title: „POLYSACCHARIDES AND POLYSACCHARIDEBASED ADVANCED MATERIALS: FROM SCIENCE TO INDUSTRY” organized by the Institute of Biopolymers and Chemical Fibres in Łódź on I authorize IBWCh to issue VAT invoice without the signature of the recipient. signature: Institute of Biopolymers and Chemical Fibres, M.Sklodowskiej-Curie 19/27 90-570 Lodz, Poland tel.: +48 42 6376744, fax +48 42 6376214 Methods of payment 1. Bank transfer to Institute of Biopolymers and Chemical Fibres, adress: M.Sklodowskiej-Curie 19/27, 90-570 Lodz, Poland, IBAN account No: PL 49 1240 3031 1978 0000 3426 6368, SWIFT: PKOPPLPW, Bank PEKAO S.A . VI O /Lodz, bank adress: Nawrot 9/11 , Lodz * For bank transfers please, state name of the participant, registration numer, which you received after sign up and add EPNOE2015 in the transfer’s title. 2. Online credit card payments will be possible after sign up. You can send to us filled Registration form via: fax: e-mail: +48 42 6376214 [email protected] or directly to: Instytut Biopolimerów i Włókien Chemicznych (Institute of Biopolymers and Chemical Fibres) M.Sklodowskiej-Curie 19/27 90-570 Lodz Poland Participants are kindly requested to arrange for their accommodation individually. Warsaw offers a wide range of accommodation possibilities. The full list of accommodation facilities in Warsaw can be found at http://www.warsawtour.pl/en and http://www.bookwarsaw.com * We suggest to participants to reserve hotel rooms early because of the conference season.
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