Registration Form

Please complete and submit the application form below before May 15th, 2012.
The entries marked with an asterisk (*) are optional.
The fee of 50 euros must be payed by bank transfer to the following data account (A inscrição unica de 50 euros deve ser paga por transferência bancária para a conta seguinte NIB):

Banco: Caixa Geral Depósitos
Titular da Conta: ADFCUP/CMUP
NIB: 003502060000845923075

Deadline: next 15th May 2012. The confirming document must be digitalized and sent to the e-mail adress dflo@fc.up.pt. Payments after the deadline suffer have a 40% increase and must be payed in the arriving day (7th May 2012).
Data limite: até ao dia 15 de Maio de 2012, devendo enviar o comprovativo em versão digital para o endereço de e-mail seguinte dflo@fc.up.pt. Pagamentos em data posterior sofrem um agravamento de 40% e serão pagos no acto de inscrição.

Last name
First name
Affiliation (organization/Institution)
Adress:
Street

City

Postal code Country

E-mail Homepage(*)

Phone number(*) Fax number(*)

Will participate in banquet

Do you wish to give a short talk (30 minutes) about a case study (of your own experience)
related with Mathematics for Industry

IF YES, PLEASE SEND US THE TITLE and a SHORT ABSTRACT
(preferably with a list of references):