Registration for the Dissemination Workshop on Nanostructured Metamaterials in Jena, Germany at 3./4. July 2012

For payment with credit card use the following form. Informations for money transfer see below.

 
Participant
Card Owner's Full Name
Card Owner's Address
ZIP/Postal Code
City
Your E-mail Address
Amount 120,00 EUR
Credit Card No.
Credit Card Check Code
(3 or 4 places in the signature field on the card back with VISA, Mastercard and American-Express)

Exp. Date:  / 
Start Date:  / 
(Only needed with some credit cards)
Credit Card Issue Number:
(Only needed with some credit cards)

Or via money transfer:

Bank account number: 830 015 03

Bank number: 820 000 00

Name of the Bank: Deutsche Bundesbank, Filiale Erfurt

Purpose of money transfer: Last name, First name + 072016 80 + workshop

For participants from outside of Germany:

IBAN: DE 0982 00000000 83001503

BIC: MARK DEF 1820

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