Registration Form

Please complete the form by filling out all the fields, click the "Submit" button below and then follow the instructions that appear on the next screen.

If there is any information you need to convey that is not covered by this form, please send it by email to web-bar@cs.unibo.it

First Name: 
Last Name:  
Sex:    Male    Female
University:   
Department:   
Street Address: 
City/State: 
Postal Code:  
Country:   
E-mail Address: 
Make sure you enter a valid email address above. To confirm your registration, you will be asked to reply to a message sent to this address.

I am a Computer Science PhD student:  Yes     No
Year of Study:  First year PhD     Second year PhD     Other

The registration fee is 900,00 Euros and includes full-board accommodation (lodging, breakfast, lunch, dinner) in a double-occupancy room from August 22, 2004 evening to September 4, 2004 noon.

You must initiate payment of the registration fee using one of the methods indicated below at the time of this registration, and in any case, not later than 31 July 2004. Extended deadline: August 16, 2004

I will be sharing the room with
(In case no roommate is indicated, organizers will pair up participants)

BICI-UNESCO(ROSTE) Grants: A limited number of BICI-UNESCO (ROSTE) grants are available for student participants. To apply, please follow the directions given in the above page and wait to receive the result before sending the workshop fee.

I have applied for a BICI-UNESCO grant:     Yes    No

Method of payment (select one):

  Banca Popolare dell'Emilia Romagna
  Filiale di Bertinoro
  Via Roma, 10
  47032 Bertinoro (FC)
  Italy

  Beneficiary: Ce.U.B. (Web Bar)
  IBAN: IT 19 N 05387 67721 00000 1052782
  SWIFT (BIC): BPMOIT22 XXX (for international bank transfers)

Please make sure that your name, address and "WEB BAR" appear on the bank transfer request. Also, make sure you send a photocopy of the transfer form to

  Ce.U.B.
  c/o Elena della Godenza (WEB-BAR)
  Via Frangipane, 6 
  47032 Bertinoro (FC)
  Italy

Cancellations: There will be a 100 Euro fee applied to the cancellation of a registration. Substitutions may be made at any time without incurring penalties.

For Italian Applicants:

A chi va intestata la fattura: 
Codice Fiscale o Partita IVA del soggetto: 

Per chi avesse bisogno, la partita IVA della Società Ce.U.B. Soc. Cons. ar.l. è 032114180402

Make sure you read and follow the instructions that appear on the next screen after hitting the "Submit" button