1. PARTICIPANT
Title (Mr, Mrs, Dr etc)* :	Dr Miss Mr Mrs Ms Prof
First name*:
Surname*:
Gender*:	Male Female
Passport No.*:
CIB membership no:
ANQIP efective member no:
Institution*:
Building no./name*:
Street*:
City*:
State*:
Postal Code*:
Country*:	--Select-- Afghanistan 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 Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burma 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 Cook Islands Costa Rica Cote d'Ivoire Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (South) Kuwait Kyrgyzstan Lao People's Democratic Republ Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States o Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niuev Norfolk Island Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadin Samoa (Independent) San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sa Spain Sri Lanka St. Helena St. Pierre and Miquelon Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kindom United States Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wales Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe
Tel*:
Fax*:
Mobile*:
Email*:
Retype email*:
VAT number*
2. ACCOMPANYING PERSON(S)
How many accompanying?*	0 1 2 3
Title Name Surname Passport No. Dr Miss Mr Mrs Ms Prof Dr Miss Mr Mrs Ms Prof Dr Miss Mr Mrs Ms Prof
3. REGISTRATION FEE
Nº of Persons EUR CIB member and ANQIP effective member* 480 Non member* 560 Student* 370 Accompanying persons* 290
NOTES: Payment instructions will be provided with acknowledgement of registration. Participant's fees cover the cost of published proceedings, admittance to the conference sessions, conference dinner, coffee breaks, lunches and the technical visits. Accompanying person fees cover the cost of programme for the accompanying persons and conference dinner. National participants, Members of Ordem dos Engenheiros, pay the same fee as ANQIP effective Members.