.........REGISTRATION FORM......
First Name
Last name
Registration
 student,
 non-profit
 industry
Email
Phone and/or cell phone
INVOICE INFORMATION
Header of invoice
Full Address
Zip code
City
Nation
Phone
Contact person
VAT Number
National identification number
or Fiscal code
or Place and date of birth
Email to send the invoice
Registration fees in euro
Student*
Non-profit
Industry
PAYMENT (wire Transfer)
Before February 22
After February 22
120
180
250
180
250
300
- Social event (Thursday 5, 20.00): 60 euros
*Students, PhD students and postdocs must have their registrar, Dean, or
Department Head certify that they are enrolled at the university as students or
certify their status as postdoctoral trainees.
BPS members will benefit 40% discount.
ULLA members and SCI (società chimica italiana) members could be eligible for
bursaries. Please contact us before register.
Date _________
Bank name: CARIPARMA
via Università n 1 - 43100 Parma, Italy
Bank Account Holder: TEFARCO Innova
IBAN: IT86O0623012700000037245655
BIC: CRPPIT2P452
Reference: your last name
Signature _________
Cancellation
Cancellation of registration until February 29th, 2016: will be refunded less a handling fee of 50 euro.
For cancellations made March 1st to April 5th, 2016: will be refunded 50% of the registration fee
For cancellations made after April 6th, 2016: no refunds can be made.
Substitutions may be made at any time.
Contacts:
Organizer: Prof. Massimiliano TOGNOLINI [email protected]
Administrative: Dr.ssa Elena Vidale email [email protected]