Slayt 1 - apmas 2012
Transkript
Slayt 1 - apmas 2012
CREDIT CARD MAIL ORDER FORM APMAS 2012 CONGRESS April 26-29 2012 I hereby authorize Albedo Turizm Tic. Ltd. Sti., Cumhuriyet Cad. Ata apt. No: 161 / 3 Harbiye Istanbul - Turkey to charge the credit card which details given below; 2. International Advances in Applied Physics Material Science Congress Participant Name and Surname : ...................................................................... ................................... Payment Today’s Date (dd/mm/yy) : ...... / ...... / ........... Card Holder’s Name : ...................................................................... ............................................ Bank name : ...................................................................... ............................................ Card Number : Card Type : Master Visa American Express Expiration Date (dd/mm/yy) : ...... / ...... / ........... CVV Number : ......... (The last three digits of the number printed on the backside of the card) Amount (In Figures) : ...................................................................... Amount (In Words) : ...................................................................... I hereby confirm that the above information are correct. Signature Name Surname Cumhuriyet Cad. Ata apt. No: 161 / 3 Harbiye Istanbul - Turkey T: +90 212 230 17 97 (pbx) F:+90 212 230 16 49 albedo@albedotour.com