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REGISTRATION FORM
Industrial Training on “Process-controlled development of new and improved polymer materials”
Dresden, 15-16. September 2014
All fields printed in red are obligatory
Participant Data
For a better service please register before July 20th 2014.
Name:
Surname:
Mr.
Mrs.
Ms.
Prof.
Dr.
Institution:
Address:
ZIP Code:
City:
Country:
E-mail:
Phone:
Fax:
Registration Fee
for one day
Standard € 100,00
(incl. 22% Italian VAT)
Student € 25,00
(incl. 22% Italian VAT)
for two day
Standard € 200,00
(incl. 22% Italian VAT)
Student € 50,00
(incl. 22% Italian VAT)
Billing Address
Please read carefully before proceeding:
The field
"VAT no. / Fiscal Code"
has obligatorily to be filled out, even in case the billing address is the same than the participant's address.
The Billing Address 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.
the billing address is the same than the participant's address.
Name:
Surname:
Mr.
Mrs.
Ms.
Prof.
Dr.
Institution(
only in case of billing to institutions and NOT to physical persons
):
Address:
ZIP Code:
City:
Country:
VAT no.
(in case of billing to
institutions
):
OR
Fiscal Code
(in case of billing to
physical persons
):
Payment
Bank transfer with reference to
Industrial Training
, specifying the name of the participant, made payable to:
ECNP S.c.a.r.l. (Via G. Giusti, 9 - I-50121 Florence - Italy - VAT no. IT 05660910489)
Account no. 5701/88
IBAN: IT 48 G 01030 02827 000000570188
BIC: PASCITM1W40
Banca Monte dei Paschi di Siena - Agency no. 01874
Via del Corso, 6 - I-50122 Florence, Italy
Please send the amount due free of any bank charges.
Credit card (VISA, Mastercard).
For payment by Credit Card, please download and print the proper form (
DOWNLOAD CREDIT CARD FORM
), fill it out
clearly
with all required information and then send it ONLY by FAX to:
Ms. Debora Puglia
ECNP S.c.a.r.l.
Fax no. +39-0744-492950
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 196/03 we wish to inform you that your personal data will be used within the
" Industrial Training on “Process-controlled development of new and improved polymer materials” Dresden, 15-16. September 2014"
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.
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