Print this page, fill it in, and fax it to +39-050-844306, or otherwise send it to the conference organizers.
Last Name: _________________________
First Name: _________________________
E-mail: _________________________
Mailing Address: _________________________
_________________________
Card type: ( ) Visa / ( ) Master Card
Credit Card N.: _________________________
Expiry date: _________________________
Name (as it appears on card): _________________________
Conference fee (by April 29): E ______
Late registration conference fee: E ______
Excursion tickets for companions: E ______
Banquet tickets for companions: E ______
Total amount: E ______
I authorize the use of my credit card for this purpose
Date: ____________________ Signature: ____________________