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REGISTRATION FORM

X^th ECNP International Conference on

Nanostructured Polymers and Nanocomposites

San Sebastian, 3-5 October 2018

All fields printed in red are obligatory

Participant Data

Name:		Surname:
Mr. Mrs. Ms. Prof. Dr.
Institution:
Address:
ZIP Code:		City:
Country:		E-mail:
Phone:		Fax:

Registration Fee

after June 30^th, 2018
Participant € 450,00 (incl. 22% Italian VAT)		Student € 250,00 (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 ECNP San Sebastian 2018, 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, by E-MAIL or FAX, to: Dr. Debora Puglia ECNP S.c.a.r.l. Email ecnp@ecnp-eu.org Fax no. +39-0744-492934 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 " Xth ECNP International Conference on Nanostructured Polymers and Nanocomposites, San Sebastian, 3-5 October 2018" 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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