Registration Form
REGISTRATION FEES (Vat 20% included)
Before
February 28, 2008
After
February 28, 2008
Delegate
€ 390,00
€ 480,00
SICCR Members
€ 330,00
€ 390,00
Daily Registration
€ 150,00
€ 180,00
SICCR Members Daily Registration
€ 120,00
€ 150,00
Trainee/Affiliate  (proof required)*
€ 240,00
€ 300,00
Gala dinner (April 15)
€ 75,00
€ 75,00

* Trainee Registration: applicants should provide an official letter from the head of their Department, University or Institution

Registrations will be considered as confirmed only upon receipt of the payment.
Family Name*
First Name*
Department/Institute
Country*
Codice Fiscale [For Italian Only]
Partita IVA [For Italian Only]
Personal Address*
Zip Code*
City*
Phone*
Fax
E-mail*
BILLING DETAILS
(fill in this part only if your billing details are different from your identification details)
Billing Heading
Address
VAT Number
Country
Codice Fiscale [For Italian Only]
Zip Code
City
Phone
E-mail
I authorize SELENE to process my Personal Data
* Data are required
FEES INCLUDE:
Delegates
Daily Registration
Conference Kit
Business Lunches
CME credits
Conference Kit
Business Lunch
CME credits
 


 
 
Selene srl P.Iva 06640240013 © 2008 | Web Design : ArduinoADV