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REGISTRATION FORM

      First name:*        Last name:*

Sex:* F   M
Occupation:*
Workplace:*
Workplace address:
Country:*
City:* Zip code:*
Street:* No:*
Home address:
City: Zip code:
Street: No:
Telephone / fax at work:*
E-mail at work:*
Telephone / fax at home:
Private e-mail:
I wish to participate at the conference as:*
Invited lecturer Lecturer
Participant With posters
Student Accompanying person
For lecturers:
I need the following technical equipment:
Slide projector
Over-head projector
Power Point facilities
Video player
Title of my lecture/poster:
Participation fees
Please, check the box that refers to you
The accomodation in Cluj-Napoca is not included in the price.
  Conference Study field trip (2 days)** Total Discounts
Participant / Lecturer 75 € 80 € 155 € If transferred by August 31, 2016
100 € 100 € 200 € -
Total:
* the price includes the participation at the presentations, the conference materials and the simultaneous translation. During the conferences the organisers will not provide accommodation and board, these expenses will be covered by the participants.
** the price includes the transportation on the study field trip, the visited object’s description, accommodation, meal and the simultaneous translation during the field trip.

In order to ease the organisation, please specify the date and means of your arrival and departure:


SPECIAL REQUIREMENTS please indicate your options*
Are you a vegetarian?
YES NO
Others (please specify the foods you can not eat if any):


TERMS OF PAYMENT:
Please transfer the total amount to be paid to the Transsylvania Nostra Fundation's bank account at least by September 30, 2016.
The organisers are not able to take into consideration demands received after September 30, 2016.

Bank account details:
Account holder's name: Fundația Transsylvania Nostra
Str. Breaza Nr. 14. 400253 Cluj-Napoca
Name of bank: Banca OTP, sucursala Cluj
Address of bank: RO-400558 Cluj-Napoca, str. Calea Floresti, no. 81
Bank account: RO74 OTPV 2010 0017 7033 EU01 (euro)
SWIFT code: OTPV ROBU

Cancellation policy for Registration:
Cancellation between September 30, 2016 and October 15, 2016 - 30% refund. No refund after October 15, 2016.

Contact details:
Mailing address: RO-400253 Cluj-Napoca, Str. Breaza Nr. 14
Tel.: +40-264-435 489
Fax: +40-264-436805
Mobil: +40-730-909630, +40-730-909636
E-mail:tusnad@transsylvanianostra.eu
           heritageconferences@gmail.com
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