biss2010 Registration Form

biss2010
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:

Male	Female

Affiliation: *

Street Adress:

City/State:

Postal Code:

Country:

E-mail address: *
Confirm e-mail: *

Field of Study:

Computer Science	Other

Year of Study:

First year	Other

You can indicate the name of your roommate if you know it. Otherwise, the organizers will pair you with a roommate.

Name of roommate:

The registration fee for both weeks is 750 Euros and includes full-board accommodation (lodging, breakfast, lunch, dinner) in a double-occupancy room. Those attending only one week need to pay 400 Euros.

Attendance:

Both weeks	First week only	Second week only

Amount to be paid:

Method of payment (select one):

Credit Card (Visa, Master Card or American Express only)
Bank transfer to:

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)

Please make sure that your name appears on the bank transfer request. Also, make sure you send a photocopy of the transfer form to:

Eleonora Campori (biss2010)
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.

Invoice of Payment:Italian law requires that an invoice be issued reflecting your payment. If you require an invoice to be issued to you personally, then make sure that you give your name and home address (not that of your institution). All fields are obligatory:

Invoice issued to: *

Address of above subject: *

Tax number (or equivalent) of above subject: *

(For Italian registrants, tax number is the "Codice Fiscale" or "Partita IVA")

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.