back



CONFERENCE REGISTRATION FORM

compulsory*
Surname*
Name*
|Birthdate |Sex
Institute*
Title
Department
Language
Address* | Number
City*
Zip code
Province
Country*  
Telephone
Mobil
Fax
E-mail*
REGISTRATION
Participant Euro 200,00 (VAT INCLUDED)
METHOD OF PAYMENT
>> Bank cheque "non-negotiable" in favour of Avenue Media
>> Wire Transfer
  • from Italy: Banca Popolare dell'Emilia Romagna, Bologna - Agenzia n° 7 - current account n° 437531 in favor of Avenue Media S.r.l. - ABI 5387 - CAB 02406
  • from EU: code IBAN: IT15V0538702406000000437531 - codice BIC: BPMOIT22
  • from abroad: SWIFT BPMOIT22 - current account n° 437531
>>
CREDIT CARD
ON LINE (encrypted data)
After clicking on the "send" button (bottom of the form) you will be automatically redirected to the on-line payment page.
INVOICING
Made out to
Address | n.
City | Postal/Zip code
Province | Country
NOTE:
Privacy details
yes | no
--------------------------------