Registration Form First Name Last Name



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History of Astronomy in Portugal:
Theories, Institutions and Practices

Lisbon, 24-26 September 2009
- Registration Form –


First Name




Last Name




Job Title




Name for Badge




Institution




Mailing Address




Postal Code




City




Country




Phone




Fax




Email







CONFERENCE FEE

Fees cover attendance to the Conference, visit to the Astronomical Observatory on September 25, coffee breaks, printed programme and book of abstracts.






Until September 11, 2009







Regular

€ 70.00




SPM, SPA or APM Members

€ 50.00




Student

€ 35.00




After September 12, 2009










€90.00







CONFERENCE DINNER

Restaurant Real Fábrica, September 26: 25 € per person

*No registrations for dinner after 31 August*








Please tick if you are a vegetarian:







History of Astronomy 2009

Total amount (Fee + Dinner)

€ ...............................




Payment



Cheque

Cheques must be drawn on a Portuguese bank and payable in Euro. Please write your name and History of Astronomy 2009 on the back of the cheque and make it payable to:

Fundação da Universidade de Lisboa

Cheque No: ..................................

Date: ..................................
All cheques should be sent to:

History of Astronomy 2009

C/o Paula Gualdrapa

Museum of Science

University of Lisbon

Rua da Escola Politécnica

P - 1250-102 Lisboa






Bank

Transfer

Bank transfer costs should be paid by participants.

Please include your name and History of Astronomy 2009 in the bank transfer description.
Account holder: Fundação da Universidade de Lisboa

Bank: Caixa Geral de Depósitos (Príncipe Real, Lisbon)

IBAN: PT50 0035 0667 0000 5616 2303 1

NIB: 0035 0667 0000 5616230 31

BIC: CGDIPTPL





Signature:





Date:












Thank you for completing the History of Astronomy 2009 Registration Form.


Please print and fax with:

  1. copy of bank transfer receipt or cheque

  2. copy of valid student ID card (if applicable)

to:
Museum of Science

C/o History of Astronomy 2009

+351 213909326

or e-mail us at

mpgualdrapa@museus.ul.pt





Registration will not be processed without proof of payment.





History of Astronomy 2009 – REGISTRATION FORM /



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