ICMGP 2015_Registration Form, International Conference on Mercury as Global Pollutant

7/25/2019 ICMGP 2015_Registration Form, International Conference on Mercury as Global Pollutant

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RegistrationFormPlease complete the registration form and send it to the ICMGP 2015 Secretariat

via email ([email protected]) or fax(+82-2-579-2662).

1. Particiant !nformation

"itle Mr. Ms. Prof. Ph.D. Other ( )

#ame $ First Last

%eartment $ Po&ition

'raniation $

*ountry $

Pone #um,er$ ex. +82-2-123-4567 o,ile #um,er ex. +82-2-123-4567

-mail $

/,&tract #o. Ex. 149996, 149997, 149998, 149999

* Please make sre to complete the pa!ment of the a"stract s"mission fee to "e eligi"le for the re#ie$%

ecial eue&t &egetarian 'ther( )

/ccomanyin Per&on"itle Mr. Ms. Prof. Ph.D. Other ( )

#ame First Last

*ountry -mail

ecial eue&t &egetarian 'ther( )

* It is mandatory to complete Items marked with asterisks(*)

2. ei&tration 3ee (/)

*ateory arly 4ir ei&tration

(4y /ril 15 2015)

eular ei&tration

(/fter /ril 15 2015)

3ull ei&tration Profe&&ional USD 700 USD 900

tuent 1 USD 550 USD 650

%aily Pa&& 2 USD 200 x _____ day(s) = USD / !". #5 (Mo") !". #6($!e) !". #%($h!)

/ccomanyin Per&on USD 200 x _____ &erso"(s) = USD

u,total USD

* Fll egistrants $ill "e entitled to attend all Scientific Programs (Plenar! Session+ Special Session+ 'ral Presentation+ Poster Presentation+

Conference ,orkshop)+ Social Programs ('pening eception+ Gala -inner)+ Lnch+ Coffee .reak+ Conference .ag(Proceedings+ Program

.ook) and /ame .adge%

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1% tuent&are reested to s"mit a #alid stdent I- to #erif! their stats $ith the Secretariat% &erification docment can "e s"mitted in file

format dring the online registration+ or "! mail ( infomercr!2015%com) or Fa3(4262657862992)%

2% %aily Pa&& :#aila"le to select either ;ne 15(Mon)+ 19( "ran&fer

6 .ank /ameA HANA BANK

6 :ccont /m"erA 166-910001-38138

6 S$ift CodeA HNBNKRSE

6 :ccont DolderA KOSEHT)

6 .ank :ddressA 46, OPAESAN-RO, SEONGBUK-GU, SEOUL, KOREA

* Cop! enclosedA Pa!ment -ateA /ame of emitterA

< Notices >

Wire transfers should be followed by a copy of bank remittance.

All bank charges for remittance must be borne by the registrant. In the case of short payments,

you will be required to pay the balance at the onsite registration desk.

!lease note that the fee must be transferred under the registrant"s name and must be stated on the receipt.

5. *ancellation Policy

E Cancellation mst "e notified to the Secretariat "! e6mail (infomercr!2015%com) or fa3(4262657862992)%

E :ll refnds $ill "e made after the Conference for administrati#e reasons%

E :ll "ank ser#ices charges and administrati#e fees $ill "e dedcted from the refnd amont%

E Please refer to the follo$ing date for cancellation%

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on /ril 0 ay 1 15 2015 3rom ay 16 2015

10 of registration fee $ill "e dedcted

from the refnd%

20 of registration fee $ill "e dedcted from

the refnd%

egistration fee $ill not "e refnded%

%ate inature AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA

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ICMGP 2015_Registration Form, International Conference on Mercury as Global Pollutant

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