Attendees » Registration Form

On-line Registration
  1. If you wish to register off-line or make changes to an existing registration, please use the PDF Registration Form
  2. Complete the form below.
  3. Select the Payment Button corresponding to your preferred payment method. Please note that registration is executed as soon the selected payment button is pressed.
  4. Credit Card information will be collected after submitting via the "Credit Card" button (Visa or MasterCard ONLY).

(* denotes a required field)

* Region:
* Institution:
* Salutation:
Gender:
First Time Attendee?:

* First/Given Name:
* Last/Family Name:
* Degree: (Ph.D., Sc.D., Dipl.-Ing., etc.)
* Nametag:
(first name or nickname...as you wish it to appear on your nametag)

* Position:
* Organization:
Department:
Division:

* Address:
* City:
State/Province:
* ZIP/Postal Code:
* Country:

(include country code before phone numbers, i.e. +1-800-555-1212)

* Phone:
Mobile:
* Email:

Advisor's Name: (*required for student discount)

Each paper, in order to be published in the conference proceedings and final program, requires at least one author to be registered as an attendee. If you are a Conference Presenter, please enter paper number(s) below.

* Classification: Conference Presenter -- Paper Number
      (If more than one, please separate with a comma)
      Has the presenting author changed since abstract acceptance?
Author
Participant

* Include email address on participant's list for all conference attendees?


* Provide name and contact information to commercial supporters and conference attendees?


Special Requirements
Dietary:
Physical:

How did you hear about the AcoustoFluidics 2019 Conference?



* Registration Type

Full Registration Fee Advanced
On or Before
16-JUL-2019

Standard
17-JUL-2019 to
28-AUG-2019

On-Site
After
28-AUG-2019

Participant €350 €500 €500
Benefactor Code:


Daily Registration Fee
(reception/banquet not included)
Advanced
On or Before
16-JUL-2019

Standard
17-JUL-2019 to
28-AUG-2019

On-Site
After
28-AUG-2019

Which Day? €125 €175 €175



Additional Guest Ticket
(For Guests of Attendees and for Dailly Registrants. Full registration fee includes entrance to both reception and banquet)

Guest Ticket €150/each


Name of Guest (if applicable; comma separated list if more than one)
First and Last Name



Pre-registration will close on August 15, 2017. After August 15, 2017, all prospective attendees will register on-site at the standard rate. Please bring this registration form with payment to on-site registration.

Registration payment, in Euros (EUR) only, is due within 10 days of receipt of your registration. Registration is not valid or complete until payment is received unless other arrangements are made. The registration fee includes program material, (1) Book of Abstracts, reception, banquet, lunch, refreshment/coffee breaks, and a 20% non-refundable cancellation fee. A €50 fee will be charged for all substitutions. All requests for refunds must be received in writing no later than 15 August 2019. No refunds will be made after this date.

* I agree to the above Cancellation Policy

For full information about our data protection practices, please follow the link to our Privacy Policy.

* I consent to the above Privacy Policy

   I do not wish to receive future information regarding the AcoustoFluidics Conference series. I would like for my personal information to be removed from the AcoustoFluidics 2019 database at the conclusion of this conference.



 



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