Prague Workshop Online Registration Tool
* required fields

* Name:
* Surname:
* Title:
* Company/Organis.:
* Mailing Address:
* City:
* Post Code:
* Country:
* Tel. Number:
FAX number:
* E-mail address:
* VAT No (Organization payment) OR Fiscal Code (Private/personal payment)
Please fill the following part carefully:
I will to attend: Friday November 11th lunch
Friday November 11th dinner
Saturday November 12th lunch
*Registration Fee

Participant outside NoE
(€ 150)

NoE Researcher
(Free of charge)

*Billing Address
Please read carefully before proceeding. Then check the appropriate button:
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.

Billing Address: Same as above
  New (Please fill in the following form)
Billing Address

* Payment type (deadline October 20th 2005):

Bank transfer with reference to "Prague NANOFUN-POLY Workshop, specifying the name of the participant, made payable to:

Consorzio INSTM
Account n. 360/01- ABI 06160 - CAB 02832 - IBAN: IT25F0616002832000000360C01 - CIN K
Banca CR Firenze SpA Filiale Enti e Tesorerie - Via Monalda 13R cap. 50121 Florence, Italy.

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

Credit card (VISA, Mastercard).

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

Mr. Daniele Consigli
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 Prague NANOFUN-POLY Workshop 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.