Please, send the completed form:
Note that you must also return a proof of your payment to complete your registration. You can send it:
Name: ________________________________________________________________
Affiliation (as it should appear on the name tag): _______________________________
Address: ______________________________________________________________
______________________________________________________________
______________________________________________________________
Telephone (including country code): _________________________________________
Fax no.: _______________________________________________________________
e-mail: ________________________________________________________________
Are you a student? ____ Yes ____No
PAYMENT INFORMATION
Registration fee:
|
Early Registration (before December 3) |
Late Registration (after December 3) |
____ Student fee: £ 280000 (145 EURO) |
____ Student fee: £ 380000 (196 EURO) |
____ Normal fee: £ 350000 (181 EURO) |
____ Normal fee: £ 450000 (232 EURO) |
____ Additional social dinner ticket (only for students): 25 EURO |
|
____ Accompanying person ticket: 80 EURO |
|
Total payment: ________
Payment method:
Phone: +39-06-4991-8508/8312 Fax: +39-06-8541842
E-mail:ciac2000@dsi.uniroma1.it