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On-Line PAYMENT FORM

2ND INTERNATIONAL CONFERENCE ON THE ECOLOGICAL IMPORTANCE OF SOLAR SALTWORKS

Please enter the requested details in the form below and press the button 'submit form' at the bottom of the form.

 
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 :
 Euro (see registration fees)
Any Comments :

I hereby authorise the 'Research Unit of the University of the Aegean' on behalf of the '10th International Conference on Environmental Science and Technology' to charge my credit card according to the details given above.


(place)                 (date)

 

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