IASTEM LISTNER REGISTRATION FORM
e-mail : info@iastem.org
web: http://iastem.org
Payment of a registration fee covers the cost to attend all conference activities, coffee breaks, conference reception and banquet, and
all lunches during the conference. In addition, each registrant will receive a copy of the conference proceedings with ISBN. Notice
that this registration fee does not cover transportation fee, accommodation fee, and after conference tour fee.
All questions and inquiries concerning registration Please complete this form and email a scanned copy to:
and payment should be addressed to: info@iastem.org
info@iastem.org
Event Name 511th International Conference on Medical, Biological and Pharmaceutical
Sciences (ICMBPS)
Venue/Place of Event Marrkech, Morocco
Date of Event 12th - 13th Dec 2018
PLEASE KINDLY FILL IN A SEPARATE REGISTRATION FORM FOR EACH CONFERENCE PARTICIPANT
University Hospital Assistant Professor
Full Name Highest
Dr.Kaarar Mohamed Nadjib in Analytical Chemistry
(Prof./Dr./Mr./Mrs) Qualification
Ferhat Abbas university, faculty of medicine, pharmacy department, analytical chemistry
Affiliation laboratory
Mailing Address ufas-webmaster@univ-setif.dz Age 34
City, Zip, Country Setif, Algeria Nationality Algerian
Mobile + 213 36620223/24 Email kmnph@live.fr
Years Of Experience Passport
5 years
(if any Academic/Industry) Number
PAYMENT INFORMATION
Total Amount (USD) Bank Name Remitter Date Ref. No
For online transfer Order ID/Traction ID:
(Debt card/Credit card/Online Banking)
Note: It is mandatory to provide a scan copy of ID Proof /Passport along with this Registration form
ADDITIONAL INFORMATION
Will you present physically at the event________________Y____________(Y/N).
No. of Persons attending the event with you?(Including your Co-authors)______.
Will your Guide/HOD/Principal attending will attend the Event?_________(Y/N).
Declaration & Undertaking Photo Here
(the photo should match your
1. I have not published this paper anywhere before and I am transferring the Copyright of my paper to IASTEM Passport)
2. I will not cause or involve in any sort of violence or disturbance within and Outside of the Conference/Event
Venue or during the travel to the venue at any Country during my Visa Period.
3. IASTEM has all rights reserved to shift the venue, rescheduling the date of the Event.
4. I do here by declare that all the information given by me is true and if at any moment it is found to be wrong
my registration for event will be cancelled by IASTEM and take necessary action against me.
5. IASTEM is not responsible for any violation of Rules and Regulations by me or by my Co-authors of this paper at
any country during the Event.
Signature (Author): ____________ Date:
Remarks: ___________
