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First Name:


Last Name:


Email Address:






Mailing address:


Type of contribution:

Invited talk Poster None   (*)

Title of the contribution:

Include your abstract into the Latex template:


(*) required fields


Please note that the registration process consists of two steps: 1) submission of the online form and 2) payment of the registration fee (see below for details). Unless you choose credit card payment, we need a statement of your bank transaction to finish the process, so we kindly request that you fax or email the following information:

- Your name

- Date of the transaction and amount

- Your bank

- Transaction number or code

Thank you very much for your cooperation.

Please note that the Conference budget does not include support for travel expenses. Pending the success of various applications for funding, we hope to provide some limited help for registration and living expenses for a few participants, especially young researchers and/or scientists from developing countries. Those requesting financial help please fill in the box below; we shall answer as soon as possible (after September 10). 

The registration fee -250 us$ before September 10, 300 us$ after September 10- includes: conference material and abstracts book; volume of the conference proceedings; welcome reception on Sunday, December 4; Conference dinner on Thursday , December 8; lunch from Monday, December 5 to Friday, December 9; coffee breaks. We can offer you three options to pay your fee after submitting this registration form, as follows:

a) Credit card (only Visa and American express, sorry!)

Print the form, fill in, sign and fax to us.

b) Bank transfer

Wire to:


4210 NW 37th Place Suite 100

Gainesville, Fl 32606

Account 2 0000 1573 0949 

ABA 0 6300 0021 

and fax to us your bank confirmation of the transaction. 

c) Check

Make the check payable to FUNDACION JOSE A. BALSEIRO INC.  and send the check to:


Dr. Angelo Ferrari

3110 NW 75th Terrace 

Gainesville, Fl 32606-6204 

Phone: (352) 378-3102 

Fax (352) 373-6925 

let us know by email that you have done so!

Our fax: THE ORGANIZERS-QBMT3- (attn. Dr. Willy Dussel) 

Fax No. (54-11) 4576-3357


Are you requesting financial assistance?
yes no