Credit Card 

 

Please charge my  Visa  American Express  Master Card/Eurocard   Card nr. _______________________________________________ Security Code ________________ Expiry date_____/_____/_____ Card holderīs name ______________________________________ Card holderīs signature ___________________________________ Total amount due ________________ Euros (Please include additional 5% charge)   Having signed below, I herewith confirm that i have read and i am fully aware of the cancellation conditions stipulated in the annoucement. I hereby authorise the XIII IEA World Congress to debit this credit card account for the total amount due. Data ___________________________ Signature _______________________

Please print, fill this form and send it by FAX to the XIII IEA World Congress Secretariat:

MUNDICONVENIUS FAX
>>> + 351 21 364 95 23

 

A Congress of IEA

Organized by:

Committees	Welcome Address	Final Programme	Registration Form
Hotel Accommodation	Social Programme	Optional Tours	Pre Congress Tours
Practical Information	Acknowledgement	Travelling

Administrative Secretariat:
MUNDICONVENIUS - Rua do Embaixador, 13 – 2 - 1300-215 Lisboa - Portugal
Tel: 351 21 364 94 98  Fax: 351 21 364 95 23 Email: info@mundiconvenius.pt