31st NATO/SPS ITM 2010
REGISTRATION FORM

Please return this form by email or fax to:
S. Trini Castelli - ISAC - CNR
Email: itm31@isac.cnr.it
Fax: 0039 0116600364

PARTICIPANT
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Title			􀀀 Mr. 􀀀 Mrs. 􀀀 Dr. 􀀀 Prof.
Institution 		-------------------------------------------------------------------------------------
Department		-------------------------------------------------------------------------------------
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REGISTRATION FEE

Pre-registration until 31st May 2009 is recommended. It covers an ITM admission badge for the week, a conference program, a CD containing the conference papers, the final conference proceedings, admission to all oral and poster sessions, coffee breaks, an evening Icebreaker Reception, an evening Formal Poster Viewing with Reception, admission to the afternoon excursion, and admission to the evening Banquet.

			
	Within 31st  May 2009	From June 1st, 2009 	
Participant fee	380 € (EUR) 	450 € (EUR) 	
Accompanying person(s) 
for conference banquet (100 €)
for excursion (30 €)	
XXX € (EUR)		
Total in € (EUR) 	TOT €:	 TOT €:	
Please, specify your special diet 	Vegetarian,vegan, others		

PAYMENT
Payment can be made by credit card (Visa or MasterCard only) or money transfer order in Euro 

I pay the registration fee by
OPTION 1
􀂆 credit card. I authorize University of British Columbia to debit my account as indicated below: 
􀂆 VISA 		􀂆 MasterCard 
account No.: XXXX XXXX XXXX XXXX           security code: XXX  (*)
Name printed on card: __________________ Exp. date: month _____ / year_____
Credit card payments will be processed within a week after receiving the registration 
(*) Security code of your card is needed. It corresponds to the last three digits printed on the signature strip after the last card numbers on the back of your card.

OPTION 2
􀂆 money order to "University of British Columbia “:
BANK: HSBC Bank of Canada, 885 West Georgia Street, Vancouver, British Columbia, Canada V6C 3G1
BANK COORDINATES: 
Transit: 10020; Institution: 016; Swift Code: HKBCCATT; Account Number:  437218-070
BENEFICIARY: University of British Columbia
Specify MOTIVATION as: 31st NATO/SPS ITM 2010 Registration + your name

To finalize the Registration a copy of the receipt of the processed money-transfer order must be enclosed to this form

A confirmation of the registration will be sent by email

Date: _______________________    Signature: _______________________________

(Cancellation must be made writing to itm31@isac.cnr.it. Refund less 50 € (EUR), for administrative costs, until July 31st; no refund after August 1st).