bsb2008 Registration Form

bsb2008
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 Address:

City/State:

Postal Code:

Country:

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

Arrival Date:

Departure Date:

If you are interested in taxi sharing, please enter your arrival time and airport below:

Arrival time/airport:

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:

I intend to give a talk:

No	Yes

If yes, title of talk:

You can choose either a single-room or a double-room for your accommodation with respective regsitration fees of 615 and 540 Euro. In case you opt for a double-room, you should arrange yourself the person with whom you will share it.

Room type:

Single	Double

Amount to be paid:: *

Payment type:

On site (credit card)	Bank transfer

Bank transfers should be made to:

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

Beneficiary: Ce.U.B. (bsb2008)
IBAN: IT 19 N 05387 67721 00000 1052782
BIC/SWIFT: BPMOIT22 XXX (for international bank transfers)

Please make sure that your name, address and "bsb2008" appear on the bank transfer request. Also, make sure you send (or fax) a photocopy of the transfer form to

Ce.U.B.
c/o Eleonora Campori (bsb2008)
Via Frangipane, 6
47032 Bertinoro (FC)
Italy
Fax: +39 0543 446557

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.