Registration for speakers/authors

Application form for speakers/authors

Important ! Please keep in mind that our approved speakers/co-authors will have free entrance to all our Congress lectures and to our Workshops .

 

1. Family name :

 

2. First name :

 

3. Birth date :

 

4. Profession :

 

5. Specialty :

 

6. Professional degree :

 

7. Work place and its address :

 

8. Correspondence address :

 

9. E-mail addresses :

 

10. Phone number :

 

11. I am a member of the Romanian Apitherapy Society: Yes /No

12. I am a member of the International Federation of Apitherapy: Yes /No

 

13. I paid the membership fees for 2014 for the membership in the Romanian Apitherapy Society (25 Eur for individual members; 50 Eur for firms/companies): Yes / No.

14. I paid the membership fees for 2014 for the membership in the International Federation of Apitherapy (50 Eur for individual members; 100 Eur for firms/companies; 150 Eur for associations): Yes / No.

 

15. I have paid my participation to the Festive dinner (Saturday evening, October 18), 25 Euro/person : Yes / No

16. I will participate to the post-Congress Tours : Yes / No.

If Yes , please mention to which of them .

 

17. I have paid the fees for my family accompanying members (relatives of first degree): Yes / No

Please mention here the complete name of the person that is accompanying you and to which events (Congress, Workshops, Tours) will accompany you: …………………………………………………………………

18. Please mention here the technical details of your payment: wire transfer number …… / date ………….. / name of the person/institution paying your Congress/Apiexpo/Workshop/Tours fees: …………………………..

for (name of participant):……………………………… in R.A.S. bank account.

 

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To be able to register faster your application form and thus ensure your place to our event, please send us, as urgent as possible, this application form and the scanned copy of your payment to : secretariat@apiterapie.ro + crispavel@yahoo.com + drstangaciu@gmail.com