Please fill in this form to register your participation in CETRA 2016.

After you have submitted the form, you will receive an e-mail with the payment details.

If you experience any difficulties with registration form submission, or have any questions regarding registration and payment, please contact Ms Lucija Brala (cetra@ulixtravel.com).

Personal information
Title

| | |

First name*:
A value is required.
Last name*:
A value is required.
Birth place*:
A value is required.
Birth date*: (dd/mm/yyyy)
A value is required.Invalid format.
E-mail*:
A value is required.Invalid format.
Repeat e-mail*:
A value is required.The values don't match.
Phone*:
A value is required.
Mobile phone:
Fax:
Institution/Company:
Address*:
A value is required.
City*:
A value is required.
Postcode (ZIP)*:
A value is required.
Country*:

Registration information
Registration type*:
Please make a selection.
Paper ID:
  (Received by e-mail from chairman if you have submitted an abstract.)
Comment:
Exceeded maximum number of characters.
If you have any special requirements (i.e. vegetarian meals, ...) please enter them here. (200 characters max.)

Payment information
Payment type:
Bank transfer - Croatia
Bank transfer - International
(+10.00EUR bank transfer fee)
Credit card (MasterCard, Visa or AMEX)
(+5% Card payment fee)
No additional payment
(Registration included in sponsorship package)
  All payments for CETRA 2016 are processed by Ulix Travel Agency (Credit Card payments through a secure payment gateway system WSPay).
Proforma Invoice: Yes   |  No
  (If you are paying by bank transfer and you need a Proforma Invoice please select "Yes". We will e-mail it to you after registration.)
Check this box to autofill form if Payment information is the same as Personal information.
First name*:
A value is required.
Last name*:
A value is required.
Institution/Company:
  (Fill in the institution to be printed on an invoice)
Tax number (VAT):
  (Institution/company VAT number. Required if invoice is addressed to an institution or company)
Address*:
A value is required.
City*:
A value is required.
Post code (ZIP)*:
A value is required.
Country*:

Fields marked with "*" are mandatory.