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E-Mail * Telephone Job title Employer APPLICABLE FEES Select applicable fee * Invited keynote speakers: EUR free Regular 2 days including Science Café: EUR 490,- Regular 1 day including Science Café: EUR 320,- Regular only Science Cafe/Accompanying Person: EUR 120,- MoniQA Association Member/Speaker 2 days incl. Science Café: EUR 380,- MoniQA Association Member/Speaker 1 day incl. Science Café: EUR 240,- On-site registration: EUR 540,- (if payment not received by 20 January 2017, on-site cash payments only) Bronze Sponsoring package: min. EUR 1.200,- including promotion package and only 1 registration, no table top Silver Sponsoring package: min. EUR 2.500,- including promotion package, table top and 2 registrations (for sponsor or any client) Gold Sponsoring package: min. EUR 5.500,- including promotion package, table top and 5 registrations (for sponsor or any client) Platinum Sponsoring package: min. EUR 7.700,- (max. two, first come, first serve) including promotion package, table top and 7 registrations (for sponsor or any client) Diamond Sponsoring package: min. EUR 10.000,- (only one, first come, first serve) including promotion package, table top and 10 registrations (for sponsor or any client), tailor made sponsorship package * Early bird reduced fee ended 15 November 2016. After 16 November 2016, the regular registration fees apply. Will you attend the full symposium including Science Café? Yes No Which days will you be attending? Thursday, 26th January 2017 including Science Café Friday, 27th January 2017 including Science Café Any special dietary requirements or allergies? Yes Please specify: PAYMENT MODALITIES Please return this form by E-mail or Fax to bari@moniqa.org OR FAX +43 590 10 11 26990 Above prices apply, if paid before the given deadlines (please note: the date of payment is relevant, not the date of registration). You will receive an electronic invoice which contains all payment instructions. Payments shall be made by bank transfer. Please note that cheques cannot be accepted. CANCELLATION AND REFUND POLICY Cancellation or changes of registration details affecting the invoiced funds must be made in written form (email/fax/letter) to bari@moniqa.org Only refund requests made before 31 December 2016 will be accepted. The refund request should be sent to bari@moniqa.org and it will be refunded after the conference (80% of the registration fee). Submit registration
