SEMOULIERS-UN.A.F.P.A. ASSEMBLEE GENERALI - ASSEMBLEES GENERALES -GENERAL ASSEMBLIES- Firenze 25-27 Maggio 2006.

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Scheda di iscrizione / Registration Form / Inscription

I dati con asterisco (**) sono obbligatori, The following data(**) are required,Les données qui sont (**) marquées sont nécessaires

Nome / Name / Nom

Cognome / Surname / Prénom

Indirizzo / Address / Rue

** | N°

Specificare se l'indirizzo è:
Specify if the address is:
Indiquez si l’adresse est:

Indirizzo privato / Private Address / Privée
Instituto /Institute Address / D’une Entreprise ou d’un Institut

Instituto / Institute / Insitut

Città / City / Ville

** | Cap/Zip code/Code **

Provincia / State / Province

Nazione / Country / Pays

E-MAIL

TEL

** | Fax

Cellulare/ Mobile/ Portable

QUOTE DI PARTECIPAZIONE / REGISTRATION FEES / FRAIS D’INSCRIPTION

La quota comprende: - Welcome Cocktail del 25 Maggio - Lavori dell’Assemblea - Coffee break e Lunch come da programma - Cena di Gala del 26 Maggio - Tour del 27 maggio		The fee includes: - Welcome reception on 25th May - The Assembly work sessions - Coffee break and Lunch as per the programme - Gala dinner on 26th May - Organised tour on 27th May	Les frais comprennent: - Cocktail de bienvenue du 25 Mai - Séances de travail de l’Assemblée - Coffee break et Lunch selon le programme - Dîner de Gala du 26 Mai - Tour du 27 Mai
DELEGATO DELEGATE DELEGUE		€ 750,00 (Iva inclusa, Vat included, va incluse)
ACCOMPAGNATORE ACCOMPANYING PERSON ACCOMPAGNATEUR		€ 500,00 - N.partecipants** (Iva inclusa, Vat included, Iva incluse)
IT) Specificare nome e cognome degli accompagnatori. UK) Please specify name and surname of accompanying persons. FR) **Prière de preciser nom prenom accompagnateur.


VISITA GUIDATA - 26 maggio inclusa nella quota accompagnatori GUIDED TOUR - 26 may included in the accompanying persons’s fee VISITE GUIDEE - 26 mai comprise dans le frais des accompagnateurs	seleziona, select, sélectionner >> N.persone, partecipants, personnes**
Cena di Gala - 26 maggio inclusa nella quota Gala Dinner - 26 may included in the fees Dîner de Gala - 26 mai compris dans le frais	seleziona, select, sélectionner >> N.persone, partecipants, personnes**
TOUR - 27 maggio incluso nella quota delegati-accompagnatori TOUR - 27 may included in the delegates and accompanying persons’s fees TOUR - 27 mai compris dans le frais des delegués et accompagnateurs	seleziona, select, sélectionner >> N.persone, partecipants, personnes**

MODALITÀ DI PAGAMENTO / METHOD OF PAYMENT / MODALITES DE PAIEMENT

Assegno Bancario intestato a Avenue Media srl, non trasferibile
Bank cheque "non-negotiable" in favour of Avenue Media srl
Chèque bancaire au nom de Avenue Media srl, non négociable

Bonifico bancario
sul c/c n° 000000 437531 intestato a Avenue Media srl
Banca Popolare dell’Emilia Romagna Ag. n° 7, Via Lame (Bologna)
ABI 5387, CAB 02406, CIN V - specificando in causale “Firenze 2006”
Wire Transfer
to A/C no. 000000 437531 addressed to Avenue Media srl
Banca Popolare dell’Emilia Romagna Ag. n° 7, Via Lame - Bologna - Italy ABI 5387, CAB 02406, CIN V - Specifying the reason for payment as “Firenze 2006”
Virement bancaire
c/c n° 000000 437531 au nom de Avenue Media srl auprès de la
Banca Popolare dell’Emilia Romagna Ag. n° 7, Via Lame (Bologna)
ABI 5387, CAB 02406, CIN V - à préciser le motif du virement: “Firenze 2006”

C/c postale: n° 18182402 intestato a Avenue Media srl,
specificare in causale “Firenze 2006” e nome del partecipante.
Postal order: to postal current account no. 18182402 addressed to Avenue Media srl, specifying the reason for payment as “Firenze 2006” and the participant’s name.
Compte courant postal: n° 18182402 au nom de Avenue Media srl,à préciser: le motif du versement “Firenze 2006” et le nom du participant.

Carta di Credito on-line
Tramite collegamento diretto sicuro verso Istituto di Credito.
All' invio del modulo di iscrizione, con questa scelta di pagamento, sarete reindirizzati automaticamente alla transazione on-line.
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.
Quand vous enverrez le formulaire d'inscription, avec cette sélection de paiement, vous serez adressé directement à la transaction en ligne.

FATTURAZIONE / INVOICING / FACTURATION

Intestazione
Made out to
Au nom de

P.Iva
VAT number
Numéro de TVA

Indirizzo
Address
Adresse

| n

Città
City
Ville

| Postal/Zip code

Pronvincia
Province

Nazione
Country
Pays

NOTE:

Privacy details

Privacy ActData marked by a (*) are not compulsory. However, failure to provide this data undermines the effectiveness and performance of the service. Data without (*) are used for administrative and fiscal purposes; you need to provide it in order to be enrolled. All the data will be gathered and processed (both manually and by computer) in compliance with the Italian legislative decree No.196/2003, also for the purpose of sending information and/or promotional material. Data will not be disseminated to external bodies, except for banks, mail delivery companies, service management companies appointed by Avenue Media, the Congress Scientific Secretariat and/or Organizing Committee. You are entitled to ask Avenue Media to update or delete your data or you can deny your permission to use it by writing to the company in charge of data processing: AVENUE MEDIA S.R.L., VIA RIVA RENO, 61 - 40122 BOLOGNA – ITALY (avenuemedia@avenuemedia.eu). You can find the entire law text containing the statement of your rights on our Web site: www.avenuemedia.eu – see “Privacy Act” link.

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