	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
Surname		-------------------------------------------------------------------------------------

First name(s)	-------------------------------------------------------------------------------------

Title		O Mr. O Mrs. O Dr. O Prof. (an X instead of O where needed)

Institution 	-------------------------------------------------------------------------------------

Department	-------------------------------------------------------------------------------------

Street-N.	-------------------------------------------------------------------------------------

Zip code	-------------------------------------------------------------------------------------

Town		-------------------------------------------------------------------------------------

Country		-------------------------------------------------------------------------------------

Phone/Fax	-------------------------------------------------------------------------------------

E-mail		-------------------------------------------------------------------------------------


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                   380 А (EUR)                  450 А (EUR) 

Accompanying person(s) 
for conference banquet (100 А)
for excursion (30 А)            XXX А (EUR)                XXX А (EUR)

Total in А (EUR)          TOT А XXX                     TOT А XXX

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 (an X instead of O where needed)

O credit card. 

I authorize University of British Columbia to debit my account as indicated below: 
O VISA 		O 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 (an X instead of O where needed)

O money order to " University of British Columbia - ЕЕ", 

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 А (EUR), for administrative costs, 
until July 31st; no refund after August 1st).