21st IEEE IOLTS 2015
Athena Pallas Village, Elia, Halkidiki,
Greece, July 6-8, 2015
Fill, Sign and Return this form
by Fax to: +30 210 6729200
or by mail to:
[email protected]
SKYLINES
Mr. Claude Harcourt
tel.: +30 210 6777779
mob.: +30 6977434546
Registration Form
Advance Registration Deadline is June 4th, 2015
PERSONAL INFORMATION
Last Name:
First Name:
Affiliation:
Address:
City:
Postal Code:
Country:
Phone:
Fax:
E-mail:
Special Meal:
FEES
IOLTS 2015 Fees
Regular 3-day Symposium
Registration Fees
IEEE/CS Member
Non Member
Student
Member1
Student Non-Member1
LATE/ON-SITE
After June 4th
 625 €
 650 €
 800 €
 350 €
 440 €
 450 €
 560 €
Additional tickets for welcome reception
45 € each X …… ticket (s)
Additional tickets for social event and dinner
90 € each X …… ticket (s)
Additional tickets for
SUB-TOTAL
ADVANCE
Until June 4th
 500 €
20 € each X …… ticket (s)
lunches2
Additional Proceedings (USB stick)
25 € each X …… copy (s)
Additional pages of the camera ready paper
75 € each X …… page (s)
TOTAL
IEEE Membership Number
€
Symposium registration fee includes welcome reception, social event and dinner and IEEE symposium proceedings (USB stick).
1
Student registration fee also includes welcome reception, social event and dinner and IEEE symposium proceedings (USB stick).
2
For non-residents at Athena Pallas Village.
PAYMENT (EUROS ONLY)
Credit card:
only accepted:
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Card number
 VISA
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Card Verification Code
 MasterCard
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Expiration date (MM/YY)
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Card holder´s name
I authorize SKYLINES EUROSKI CLUB Ltd to debit my credit card for the total amount of: ______________ €
Date:________________
Signature: __________________
CANCELLATION AND REIMBURSEMENT POLICY
Any cancellation made in writing to IOLTS’15 Organization and received before June 4th, 2015 will entitle to the reimbursement of the
amount paid after deduction of 50 € for administrative fee. No reimbursement will be granted after this date. Substitutions are free.
__________________
For bank trasfer please contact Mr. Claude Harcourt ([email protected]).
For any information please contact the General Co-Chair Prof. Antonis Paschalis ([email protected]).