ICTCS 2003
Registration Form

Please make sure that all fields are completed before submitting the form

If there is any information you need to convey that is not covered by this form, please send it by email to register-ictcs03@cs.unibo.it

First Name:
Last Name:
Sex: Male Female
Affiliation:
Street Address:
City/State:
Postal Code:
Country:
E-mail Address: (Must be a complete address including domain, e.g. pinco@pallino.com)
Telephone: +- (Optional)
Fax: +- (Optional)
Special needs (dietary,...):


Registration Fee Schedule

Registration form received
 by 20 September 2003   after 20 September 2003 
€200 €240

The registration fee includes conference proceedings, welcome dinner, banquet, coffee breaks, bus service, use of computer room. It also includes one year-subscription to EATCS and two-years subscription to the Italian Chapter of EATCS. Costs for accommodation at the University residential center (per person/per night):

Single Room €55
Double Room €45

Type of accommodation requested (select one):
Single occupancy
Double occupancy I will be sharing the room with

Arrival on   Departure on The accommodation is requested for nights.

Amount to be paid
For registration: €
For accommodation: €
Total: €

Method of payment (select one):
Credit Card (Visa or MasterCard only) Please complete, print, sign and fax this form to +39 0543 446599
Bank transfer to 

  Banca Popolare dell'Emilia Romagna
  Filiale di Bertinoro
  Via Roma, 10
  47032 Bertinoro (FC)
  Italy

  Beneficiary: Ce.U.B. (ICTCS03)
  Account Number: 1052782
  Swift code: BPMOIT 22 (for international bank transfers)
  ABI 05387   CAB 67721 (for bank transfers within Italy)

Please make sure that your name, address and "ICTCS03" appear on the bank transfer request. Also, make sure you send a photocopy of the transfer form to 

  Ce.U.B.
  c/o Elena della Godenza (ICTCS03)
  Via Frangipane, 6 
  47032 Bertinoro (FC)
  Italy
For Italians only: Invocing details
Fatturare a: Partita IVA:
In alternativa, se non si desidera fattura, Codice Fiscale:

For questions related to the payment only, you can contact directly Elena della Godenza (Tel +39 0543 446594, Fax +39 0543 446599, Email: edellagodenza@centrocongressibertinoro.it)


Grants

A limited number of grants will be provided to students to cover part of the expenses. If you are a student and want to apply for a grant, please check the box
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