| Identification details |
|
Please complete this section accurately.
* = compulsory field |
| FAMILY NAME |
* |
| FIRST NAME |
* |
| TITLE |
|
| INSTITUTION/ORGANIZATION |
|
| DEPARTMENT |
|
| PERSONAL ADDRESS |
* |
| CITY |
* |
| ZIP CODE |
* |
| STATE/PROVINCE |
|
| COUNTRY |
* |
FOR ITALIANS ONLY !
inserire il codice fiscale |
|
| E-MAIL ADDRESS |
* |
TELEPHONE
(country code, city code, number) |
-
-
* |
FAX
(country code, city code, number) |
|
FOR ITALIANS ONLY !
inserire numero di appartenenza all’ordine |
|
| |
| Billing details |
Fill this part only if your Billing details are different from your Identification details.
* = compulsory field |
| BILLING HEADING |
* |
| BILLING ADDRESS |
* |
| VAT NUMBER |
|
FOR ITALIAN COMPANIES ONLY !
inserire il codice fiscale |
* |
FOR ITALIAN COMPANIES ONLY !
inserire la partita IVA |
* |
| CITY |
* |
| ZIP CODE |
* |
| STATE/PROVINCE |
|
| COUNTRY |
* |
PLEASE PROVIDE A PHONE NUMBER FOR INVOICES QUERIES
(country code, city code, number) |
|
IMPORTANT NOTICE: If a different heading is not specified in the Billing Details, the invoice will be made out according to the information provided in the Identification Details section.
|
| |
| Registration Fees (EURO, 20% Vat included) |
| Isge Members |
€750.00 |
|
|
|
|
|
| Non Isge Members |
€1000.00 |
|
|
|
|
|
| Gala Evening |
€120.00 |
|
|
|
|
|
| Isge Members |
|
€750.00 |
|
|
|
|
| Non Isge Members |
|
€1000.00 |
|
|
|
|
| Gala Evening |
|
€120.00 |
|
|
|
|
|
| Payment details |
Please check the appropriate box and process the payment referring to the instructions appearing in each method of payment.
Registrations will be considered as confirmed only upon receipt of the payment. |
Check
::
Bank Transfer::
Credit Card or PayPal::
|
REGISTRATION FEE FOR THE DELEGATE INCLUDES
Opening Ceremony, Closing Ceremony, Access to all sessions and exhibition area, Congress kit, Abstract Book, CME credits and/or ECM credits, Password to access the Congress on-line.
CANCELLATION POLICY FOR REGISTRATION
Refunds (less € 25,00 for taxes and administrative expenses) will be granted to delegates unable to attend. A written notice must be received by the Organizing Secretariat before September 30th, 2010. No refunds will be made for cancellations received after September 30th, 2010. All refunds will be issued after the Congress.
|
PERSONAL
DATA PROTECTION - LAW N. 196/2003
|
|
|