Registration Form

Darkside Collaboration 2019 General Meeting at Napoli
Naples, 11/15 November 2019

rEGISTRATION FORM

Please, fill the Registration Form.

FISCAL DATA FOR INVOICE

* Indicates required field

Family Name *

First Name *

INVOICE HEADING *

Address *

Post code *

City *

Country *

Phone *

Mobile *

e-mail *

Registration Fee

SOCIAL DINNER € 42.00 (VAT included) POMPEI ** € 33.00 (VAT included)

**on the invoice it will be mentioned as "Congress Fee"

***Italian Participants who need the invoice headed to public institution (INFN, University and s.o.) must deduce VAT.
Please, in this case use the following prices:

SOCIAL DINNER € 38.18 POMPEI** € 27.05

**on the invoice it will be mentioned as "Congress Fee"

Accompanying Persons

N° *

SOCIAL DINNER € 42.00 (VAT included) POMPEI ** € 33.00 (VAT included)

Food Intolerances *

TOTAL € *

PAYMENT *

BANK TRANSFER
Bank Transfer to “STUDIOCONGRESS sas” – Unicredit Banca – Ag. 1 Filangieri – Naples (ITALY)
IBAN IT 14 B0200803466000103134213 SWIFT UNCRITM1G40
specifying as reason for payment "Participation Darkside Collaboration 2019 General Meeting at Napoli + Name of Participant"

CREDIT CARD *

VISA MASTERCARD

Number *

Expiry Date (mm/aaaa) *

Cardholder *

Secure Code *

Authorization *

I authorize the payment

Pursuant to art.13 of the legislative decree 196/2003 and successive amendments, I hereby express my consent to the processing of my personal data by Studiocongressto the following purposes. I also confirm that I accept the canellation policy.

Date *

Via dei Mille 16, 80121 Napoli
Tel. 081 18891223 / Fax 081 18891224
e-mail: [email protected] www.studiocongress.it

INVIA