International Conference on Supercritical Fluid Technologies and

PARTICIPATION FORM
International Conference on Supercritical Fluid Technologies
and Applications
”Supercritical fluids – the current state and outlook”
Puławy, 20-21.10.2016
CONTACT DATA
Name and surname
Scientific title
Position
Institution (name, address)
VAT
No.
phone/mobile
email
COUNTRY
PRESENTATION
Authors (underline surname of
the presenting person)
Presentation title
Submission of the presentation
for publication in the monograph
YES ☐
NO ☐
FEES
Conference fee covers participation in the conference, board, conference materials, gala dinner.
Conference fee: 200 €
Conference fee payment
Payment: bank tranfer:
Payment for
Instytut Nowych Syntez Chemicznych
conference should be
Al. Tysiąclecia Państwa Polskiego 13A, 24-110 Puławy, POLAND
made by transfer to the Raiffeisen Bank SA
specified bank account Swift RCBWPLPW
by 23.09.2016
Bank account number:
IBAN: PL 16 1750 1107 0000 0000 2187 0706
Transfer title: ICSFTA2016 surname and name
SPECIAL EVENTS
Tour of supercritical extraction department in Instytut Nowych Syntez
Chemicznych 20.10.2016., 3 p.m. – 5 p.m.
YES ☐
NO ☐
Visiting the Zamoyski Museum in Kozłówka 22.10.2016, cost: 35 €
YES ☐
NO ☐
Confirmation of hotel reservation directly at hotels (price discount guaranteed if reservation made by 23.09.2016).
☐ I hereby give my consent to have my personal data processed by Instytut Nowych Syntez Chemicznych/ New Chemical
Syntheses Institute seated in Puławy at Aleja Tysiąclecia Państwa Polskiego 13A in oder to organize International
Conference on Supercritical Fluid Technologies and Applications - ICSFTA, pursuant to the Act of 29th of August 1997
on personal data protection (the Official Journal of Laws of the Republic of Poland Dz.U. of 2002 No101 item 967 with
further amendments). My personal data can be made available by Instytut Nowych Syntez Chemicznych to third parties
who are for responsible for the preparation and organization of the conference upon the concluded separate agreements.
www.icsfta.pulawy.pl