ARS, Europe2012 International Applied Reliability
Symposium, Europe

March 28 - 30, 2012
Warsaw, Poland

Submit Registration to ReliaSoft Corporation Poland Sp. z.o.o.:
Phone: +(48) 22 436 67 70      Fax:+(48) 22 436 67 99
Mail: ul. Skwer Ks. Kard. St. Wyszyńskiego 5, lokal nr 14, 01-015 Warsaw, Poland

Registration Information - One Form Per Attendee
   Advanced Registration (must be received by February 7, 2012) 
   Standard Registration 
   Full-Time Student (Student ID Required) 

€795.00
€895.00
€395.00
VAT Registration Number
 
Payment Method
 Company Purchase Order (attached, NET 30 basis)

 		Telegraphic Transfer
BRE BANK S.A. w Warszawie
Bank Swift Code: BREXPLPWWA1
IBAN (for EURO Payments): PL72 1140 1010 0000 5009 7100 1003
IBAN (for USD Payments): PL02 1140 1010 0000 5009 7100 1002
IBAN (for PLN Payments): PL29 1140 1010 0000 5009 7100 1001

All Bank charges to be borne by payer. Please ensure that ReliaSoft Corporation Poland receives the full invoice amount.
 Credit Card (Vcode and credit card billing address are required. Please indicate the billing address below or provide it separately.)
Card Type:
  Visa MasterCard American Express

Card Number:
_________________________________________ Expires: _________ Vcode: __________
Name on Card: ________________________________________________________________________________
Signature: ________________________________________________________________________________
Attendee Information Billing Information (if other than attendee)
Same as credit card billing address.  
Name: ______________________________
Company: ______________________________
Address: ______________________________
______________________________
______________________________
Phone: ______________________________
Fax: ______________________________
E-mail: ______________________________
Same as credit card billing address.  
Name: ______________________________
Company: ______________________________
Address: ______________________________
______________________________
______________________________
Phone: ______________________________
Fax: ______________________________
E-mail: ______________________________
Additional Information
- Hotel Reservations: You will need to make reservations on your own. Please contact the hotel directly.
- Substitutions: Substitutions are allowed provided that ARS is notified 7 days prior to the Symposium start date.
- Cancellations: Cancellations received up to 15 working days prior to the start date will be entitled to a full refund of the registration fee minus a 50 administration fee. After this period, all cancellations will be subject to the full fee.
- No Shows: Registrants who do not attend and do not notify ARS of cancellations are subject to the full registration fee.
- ARS reserves the right to cancel/reschedule the Symposium at any time up to 4 weeks prior to its start date. In the event of cancellation, all registration fees will be refunded. ARS is not responsible for any other charges, such as non-refundable airline tickets.
- Registration fee includes attendance to all presentations, copies of the proceedings and any other handouts, the Thursday night reception, daily lunch (Wednesday and Thursday) and refreshments provided during the breaks. A certificate of attendance will be provided.