WebBar2009
Registration Form

Please complete the form by filling out all fields and then click the "Submit" button below. Fields marked with an * are obligatory.

First Name: *

Last Name: *

Sex:

Affiliation: *

Street Address:

City/State:

Postal Code:

Country:

E-mail address: *
Confirm e-mail: *

Arrival Date:

Departure Date:

In accordance with Italian law, an Invoice reflecting the registration fee will be issued to the above subject with the following ID Number (for Italians: "Codice Fiscale" or "Partita IVA", for Americans: Social Security Number; for all others: the equivalent National Identification Number)

ID Number:

Regular registration is 1000 euros, unless agreed differently with the organizers. Student registration is 800 euros and entitles to accommodation in a double room

Room type:

Name of roommate:

Are you the recipient of a Leonardo Melandri grant?

Grant:

Amount to be paid:

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

Beneficiary: Ce.U.B.
IBAN: IT 19 N 05387 67721 00000 1052782
SWIFT (BIC): BPMOIT22 XXX (for international bank transfers)

Eleonora Campori (WebBar2009)
Via Frangipane, 6
47032 Bertinoro (FC)
Italy

Cancellations: There will be a 100 Euro fee applied to the cancellation of a registration. Substitutions okayed by the organziers may be made at any time without incurring penalties.

By clicking the "Submit" button, you are agreeing to the use of your personal information by CeUB for the sole purpose of handling your registration to the event in question. The information you have provided will not be communicated to any other parties. Should you wish to exercise your rights regarding the protection of personal data under Italian law, please contact CeUB in writing at: Via Frangipane 6, 47032 Bertinoro (FC) Italy.

Make sure you read and follow the instructions that appear on the next screen after clicking the "Submit" button.