REGISTRATION FORM
	              
Paper ID: _______
First name: _____________________ Last name (family name): ________________________    Affiliation (Institution, country):__________________________________________________
Phone: ______________   Fax: ______________ E-mail:______________________________
The publication of the paper at ISETC 2014 is conditioned by the registration of at least one author until October 10, 2016. 
Only the papers that will be presented in the conference sections will be sent to the IEEE in order to be included in the IEEE Xplore database.
Registration fee (please mark with an X):
	Before September 23rd, 2016	After September 23rd, 2016	
General	 200 Euro	 250 Euro	
IEEE member, number _________	 200 Euro	 200 Euro	
Student	 75 Euro	 75 Euro	
Reduced fee*	 75 Euro	 75 Euro	
IEEE members: please include your IEEE number. Students: please include a proof from your university that you are in fact an undergrad/postgrad or a doctoral student. Registration fee includes admission to all conference sessions, one sample of the proceedings (for student and reduced fee only CD-ROM), coffee breaks and cocktail.
*A limited number of accepted papers, proposed by young authors coming from East European and developing countries, will be partially sponsored, upon request.
Other fees (please mark with an X):
	Before September 23rd, 2016	After September 23rd, 2016	
Attendants/co-authors	 75 Euro	 100 Euro	
Extra-paper	 50 Euro/paper	 50 Euro/paper	
PAYMENT FORM:
Registration fee payment should be done before sending this form.
Bank transfer (please refer to “ISETC 2016 Symposium” and indicate the participant name and paper ID)
Country: ROMANIA
Bank: BRD Group Societe Generale Romania, 
Bank address: Socrates street nr.1 Timisoara, ROMANIA
Account owner: ASOCIATIA INGINERILOR ELECTRONISTI TIMISOARA
Account number:
	RON:	  RO58BRDE360SV60771023600
	EURO:     RO38BRDE360SV68561493600  
SWIFT code: BRDEROBU 
Owner address: Bd. Vasile Parvan No. 2; 300223 Timisoara, Romania; E-mail: septimiu.mischie@etc.upt.ro
VAT number: 10227265	
Please send us a copy of the payment order at simpo.etc@upt.ro.
Payment date:    _________ 
Invoice number: _________

ACCOMODATION:
•	Request accommodation for: 
Days (please mark with an x in the box):

 26 Oct. (Wednesday) ,  

 27 Oct. (Thursday) ,  

 28 Oct. (Friday) , 

 29 Oct. (Saturday)  

Please note that, after the registration is closed, we will inform you how to proceed for room booking.

Comments / (additional requests) to the Organizing Committee:

Please send the completed form to simpo.etc@upt.ro, after registration fee payment.