Registration form - 29th Pezcoller Symposium

REGISTRATION FORM

* Required field

Please register using this form within the 1st of June 2017.

Last Name *

First Name *

Affiliation *

Address *

Phone *

E-mail *

OriKata organizzazione congressi, in accordance with Legislative Decree 30 June/2003 no. 196, declares that the above data will be used only for registration and activities strictly connected with the event. Our data processing is in conformity with the updated law. You may, at any time, exercise your rights pursuant to art. 7 of Italian L. Decree 196/2003, in particular ask for the amendment or cancellation of your data from electronic archives free of charge. I authorize the treatment of my personal data *

Posters

I will submit a poster (deadline 22nd May 2017)

Method of payment

€ 200 (as a contribution to Symposium’s expenses) is preferably payable by bank transfer:

Account name: Fondazione Pezcoller, Via Dordi 8 Trento - Italy
Bank name: Unicredit, via Galilei 1 - Trento Italy
Account number/IBAN: IT 26 K 02008 01820 000033200502
Swift Code/BIC: UNCRITM10HV

Please attach here the receipt of the payment made out to Pezcoller Foundation.

Thank you

Thank you for your registration.
Important details for your participation will be sent by the organization after the deadline of 1st June.

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