Registration Form

Please complete the form by filling out all the fields, click the "Submit" button below and then follow the instructions that appear on the next screen.

If there is any information you need to convey that is not covered by this form, please send it by email to mac@cs.unibo.it

First Name: 
Last Name:  
Sex:    Male    Female
Affiliation (University or Company):   
Department:   
Street Address: 
City/State: 
Postal Code:  
Country:   
E-mail Address: 
Make sure you enter a valid email address above. To confirm your registration, you will be asked to reply to a message sent to this address.

I am a Computer Science PhD student:  Yes     No
Year of Study:  First year PhD     Second year PhD     Other

Registration Fee:

• Students and academics: The registration fee for students and academics is 700 euros and includes full room-and-board accommodation (lodging, breakfast, lunch, dinner) in a double-occupancy room from September 3, evening, to September 9, noon.

• Companies: The registration fee for companies is 2,000 euros and includes full room-and-board for the same period, but in a single-occupancy room.

You must initiate payment of the registration fee using one of the methods indicated below at the time of this registration, and in any case, not later than August 20, 2005 (new collateral-damage-line)

I will be sharing the room with
(In case no roommate is indicated, organizers will pair up participants)

Arrival date
Departure date

Method of payment (select one):

Credit Card (Visa or MasterCard only). Please save the credit card authorization form on your local disk, complete it electronically, print it, sign it and fax it to +39 0543 446599

Bank transfer to

  Banca Popolare dell'Emilia Romagna
  Filiale di Bertinoro
  Via Roma, 10
  47032 Bertinoro (FC)
  Italy

  Beneficiary: Ce.U.B. (BICI MAC)
  IBAN: IT 19 N 05387 67721 00000 1052782
  SWIFT (BIC): BPMOIT22 XXX (for international bank transfers)

Please make sure that your name, address and "Math and Crypto" appear on the bank transfer request. Also, make sure you send a photocopy of the transfer form to

  Ce.U.B.
  c/o Elena della Godenza (MATH-AND-CRYPTO)
  Via Frangipane, 6 
  47032 Bertinoro (FC)
  Italy

Cancellations: There will be a 100 Euro fee applied to the cancellation of a registration. Substitutions may be made at any time without incurring penalties.

Invoice of payment

Note: If you want the invoice to be issued to you personally, then make sure that you give your name and home address (not that of your institution).

The following two fields are mandatory.
Invoice issued to  
Address  

For questions related to payments and accommodation, please contact

Elena della Godenza
phone +39 0543 446500
fax +39 0543 446557
email: edellagodenza@ceub.it

For any other questions, please contact mac@cs.unibo.it

Make sure you read and follow the instructions that appear on the next screen after hitting the "Submit" button