Please complete all obligatory fields indicated by an asterisk (*).
Personal Information  
* Name:
* First name:
* Title:
* Comp./Organis./Instit.:
* Mailing Address:
 
 
 
* City:
* ZIP Code:
* Country:
* Tel. Number:
   Fax Number:
* E-mail address:
* VAT No / Fiscal Code
(VAT for organization, FC for private/personal payment)
 
 
* Registration Type and fees (please choose one)
Prices for registration before March 1, 2008
- Participant: € 300 incl. 20% Italian VAT
(After March 1, 2008: € 350 incl. 20% Italian VAT)
- Participant also registered to the NANOFUN-POLY'S 2nd Young Polymer Scientists Conference and 6th Short Course in Terni:
€ 200 incl. 20% Italian VAT
(After March 1, 2008: € 250 incl. 20% Italian VAT)
- Student: € 150 incl. 20% Italian VAT
(After March 1, 2008: € 175 incl. 20% Italian VAT)
- Student also registered to the NANOFUN-POLY'S 2nd Young Polymer Scientists Conference and 6th Short Course in Terni:
€ 100 incl. 20% Italian VAT
(After March 1, 2008: € 125 incl. 20% Italian VAT)
 
* Billing Address (please choose one)
Please read carefully before proceeding.
This is the address the relevant invoice should be ISSUED to. Please note, that in case of credit card payment the invoice obligatorily has to be issued to the cardholder. Example: You CANNOT use your personal credit card, if you want the invoice to be issued to your institution (or vice versa). Kindly keep in consideration this important point while compiling the following fields.
Same as above New
 
* Payment type (please choose one)
1. Bank transfer
The transfer must reference "4th International Symposium on Nanostructured and functional polymer-based materials and composites” (NANOFUN-POLY) ", specifying the name of the participant and must be made payable to:

ECNP Account Number: 5701/74
IBAN: IT 56 W 03400 02800 000000570174
BIC: TOSCIT3FXXX
Banca Toscana – Capogruppo di Firenze
Via del Corso, 6 I
50122 Florence, Italy

Note: Please send the total due amount free of any bank charges.

2. Credit card (VISA, Mastercard)

For payment by Credit Card, please download and print the proper form (Authorisation for Credit Card Payment), fill it out clearly with all required information and then send it ONLY by FAX to:

Ms. Sabine Danieli
ECNP, c/o Consorzio INSTM
Fax no. +39-055-2480111 (reserved line)

IMPORTANT: The above mentioned form DOES NOT substitute the present Registration Form. Sending ONLY the form for the credit card payment DOES NOT complete your registration.

 
ATTENTION! Your registration will be valid only with your acceptance of the conditions reported below:
With reference to the Italian law 675/96 we wish to inform you that your personal data will be used within the "3rd International Symposium on “Nanostructured and functional polymer-based materials
and composites” (NANOFUN-POLY)" institutional activity. We also wish to inform you that your personal data will be inserted in the participant list relevant to the present event.
 
I herewith confirm that I agree that my submitted data concerning addresses, booking and methods of payment be electronically stored and processed in order to organize and manage this event. Furthermore, I accept that address and personal data are used for purposes connected to the event's management and will be published in the list of participants.
   
     



Vatican and Tiber River


Roman Forum and the Colosseum


Spanish Steps


Trevi Fountain


 

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