FACULDADE DE LETRAS DA UNIVERSIDADE DE COIMBRA

20th to 22nd of November 2017

REGISTRATION FORM

Name ____________________________________________________________________

Address __________________________________________________________________

Telephone/Mobile Number _________________________________________________

E-mail ___________________________________________________________________

Institution _______________________________________________________________

Passport Number (optional)_________________________________________________

Type of Inscription: presenting a paper without presenting a paper

Price of Inscription:

Participants Students

With a paper 30,00€ With a paper 20,00€

Without a paper 15,00€ Without a paper 15,00€

Date __/ __/ ____ Signature _______________________________________________

Payment:

Bank transfer (identified with your name and FF5) to:
Banco Santander Totta S.A.
Universidade de Coimbra
IBAN: PT50 0018 000040523858001 05
BIC SWIFT: TOTAPTPL
Bank ______________________________________________________________
Amount_______________________________________________________________

If you need a receipt, please send your full name, address and fiscal number (in case you
have one), as well as the one of your institution, when necessary.

Please print this form and send digitalized to: clp@fl.uc.pt

For further information:
https://www.uc.pt/fluc/clp/not/5ciff
https://figurasdaficcao.wordpress.com/2017/07/18/5o-coloquio-internacional-figuras-da-ficcao/

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