ECDO 2014

CREDIT CARD DETAILS

(To be sent as an e-mail message attachment to:
 info@ecdo2014.gr, or faxed to +30-2810-391101)

General Information

Participant(s) name(s): 	

Affiliation: 	

e-mail address: 	

Total amount to be charged: €	

Credit Card:

Type: 	VISA [   ]   	or 	Master Card [   ]
Card Number: 		
CVV:		(the last 3 digits of the number at the back of the credit card)
Valid until:		(mm/yy)
Holder’s name:		
Signature: