Registration and Hotel Reservation Form Participant Name* Family Name* Passport Nr.* e-mail* Observations For invoice and badge Institution / Company* VAT number Street Address* Address Line 2 City* State / Province / Region* Postal / Zip Code* Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other-Not Shown Country* Registration ATTENDANCE TYPE Early RegistrationUntil 15 July 2016 Late RegistrationFrom 16 July to 5 September 2016 Member fee (1) 375 € 425 € Non member fee 450 € 500 € Student member fee (2) 225 € 275 € Student non member fee (2) 285 € 325 € Accompanying person 400 € per person 0 1 2 3 4 5 6 7 8 9 Additional tickets for Gala Dinner 50 € per person 0 1 2 3 4 5 6 7 8 9 Special food requirements for Participant / Accompanying person (eg Gluten free, Vegetarian) No Yes (1) Memberships considered: SPFV (Sociedade Portuguesa de Fisiologia Vegetal); SEFV (Sociedad Española de Fisiología Vegetal); APH (Associação Portuguesa de Horticultura); SBFV (Sociedade Brasileira de Fisiologia Vegetal); SBF (Sociedade Brasileira de Fruticultura) (2) A proof of your student status will be required for registration. • Cancellation must be always confirmed in writing: Don't forget to include all your bank's information. All cancellations must be notified before 31 July 2016. All refunds are subject to an administrative fee of 100 €. After this date, no refunds. Taxi Transfers Requested transfer Rate Flight number Date and timedd-mm-yyyy hh:mm Airport Alicante to Thalasia Hotel 93 € Thalasia Hotel to Airport Alicante 93 € Airport San Javier to Thalasia Hotel 36 € Thalasia Hotel to Airport San Javier 36 € Murcia Bus Station to Thalasia Hotel 57 € Thalasia Hotel to Murcia Bus Station 57 € Hotel Thalasia Accommodation Need hotel reservation ? Yes No Check-in date select 2016-09-19 2016-09-20 2016-09-21 2016-09-22 2016-09-23 2016-09-24 2016-09-25 2016-09-26 2016-09-27 2016-09-28 2016-09-29 2016-09-30 2016-10-01 2016-10-02 2016-10-03 2016-10-04 2016-10-05 2016-10-06 2016-10-07 Check-out date select 2016-09-19 2016-09-20 2016-09-21 2016-09-22 2016-09-23 2016-09-24 2016-09-25 2016-09-26 2016-09-27 2016-09-28 2016-09-29 2016-09-30 2016-10-01 2016-10-02 2016-10-03 2016-10-04 2016-10-05 2016-10-06 2016-10-07 Room type Single room (67 €) Double room (77 €) Triple room (97 €) Occupant name 2 Occupant name 3 • Cancellation must be always confirmed in writing to congresos@verticesur.es • Don't forget to include all your bank's information. Reservation changes will only be possible before the hotel/transfer confirmation is mailed. After that, reserves the right to charge additional 25 € for reservation changes. All cancellations must be notified by 31 July 2016. After this date, no refunds are possible. Payment Only registration forms properly filled in and accompanied by their proof of payment will be processed. Registration will only be confirmed once payment has been checked by the Technical Secretariat. Bank transfer (free of charges) to: VERTICE SUR Beneficiary address: C/ Platería 29 C.P. 30001 Murcia Please remember to indicate on the heading/subject of the bank transfer:"NUTRIPLANTA16/ Family Name, Name" Savings Bank: BMN Bank Bank's address: Plaza de las Flores, nº 2 C.P.: 30004 Murcia Bank account (IBAN): ES18 0487 0106 2520 0700 6274 Swift/Bic Code: GBMNESMMXXX Credit card (be charged a 1% additional) Card type Card holder Card number Expiring date 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 1 2 3 4 5 6 7 8 9 10 11 12 CVV code CVV Security code (three last digits on the side of the signature) I accept terms and cancellation policy expressed in this website