On-Line Payment CEST2011

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On-Line PAYMENT FORM

12^TH INTERNATIONAL CONFERENCE ON ENVIRONMENTAL SCIENCE AND TECHNOLOGY
CEST2011

Please enter the requested details in the form below and press the button 'submit form' at the bottom of the form. Alternatively you may send your payment by check to the Conference Secretariat :

12th International Conference on Environmental Science and Technology (CEST2011)

Secretariat
30, Voulgaroktonou str.,
GR 114 72 Athens, Greece
Tel.: + 30 210 6492450, 6492452

Fax: + 30 210 6492499
E-mail: cest2011@aegean.gr

Identification :
Name Registered in the Conferenece:	First Name: Last Name:
E-mail address :

Credit Card details :
Card Type :
Card Number :
Card Holder :	(Please type exactly as it appears on the credit card)
Expiration Date :
Amount :	Euros (see registration fees)

*Any Comments :*

I hereby authorise the 'Research Unit of the University of the Aegean' on behalf of the '11^th International Conference on Environmental Science and Technology' to charge my credit card according to the details given above.

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e-mail to: cest2011@aegean.gr