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 recombSat@cs.unibo.it

First Name: 
Last Name:  
Sex:    Male    Female
University:   
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.

Cost:

• The workshop fee is 250 euros for early registration (by October 7) and 300 euros for late registration (October 8 and after)

• Full Board Accommodation: The daily room-and-board accomodation fee includes full board accommodation and coffee breaks and it is: Euros 115.00 for single room accommodation, per person, per day; Euros 105.00 for accommodation in a double room, per person, per day

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 October 12, 2004.

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

I will arrive on
I will depart on

BICI-UNESCO(ROSTE) Grants: A limited number of BICI-UNESCO (ROSTE) grants are available for student and young researchers. To apply, please follow the directions given in the above page and wait to receive the result before sending the workshop fee.

I have applied for a BICI-UNESCO grant:     Yes    No

Method of payment (select one):

Bank transfer to

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

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

Please make sure that your name, address and "RECOMB" 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 (RECOMB SAT)
  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.

Financial information

Invoice to be addressed to
Address
Social Security Number

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