LACNEM2009 - LatinAmerican Conference on Networked and Electronic Media

Registration

Personal Information

Title

Passport number

First name*

Last name*

Affiliation

Address

City

State

Country |

Phone
(+country code / area code / phone)

Fax (+country code / area code / fax)

E-mail* |

Special request
(Special food requests, such as vegetarian or something else to have in mind)

Registration Options

		International payment (USD)
Early registration before 15th July 2009	Student:	$100
Early registration before 15th July 2009	Regular:	$150

Author's early registration before 15th July 2009	Student:	$80
Author's early registration before 15th July 2009	Regular:	$100

Late registration after 15th July 2009	Student:	$200
Late registration after 15th July 2009	Regular:	$300

Group registration	Students (15 participants)	$1.200
	Academics (15 participants)	$1.500
	Corporative (12 participants)	$1.500

Student's certification

(max 2MB)

Payment Options

Bank deposit copy

(max 2MB)

Deposit information:

Bank: Banco Popular
Account name: Facultad de medicina.
Payment reference: 20193323
Account number: 01272005-8
SWIFT Code: BPOPCOBB

Invoice

Company name

Address

City

State

Country |

Phone
(+country code / area code / phone)

Fax (+country code / area code / fax)

Contact name

Tax ID number

Last update: June 24, 2009