INTERNATIONAL CENTRE FOR GENETIC ENGINEERING ... - ICGEB

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11 Δεκ 2012 (πριν από 4 χρόνια και 9 μήνες)

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INTERNATIONAL CENTRE FOR GENETIC ENGINEERING AND BIOTECHNOLOGY


ICGEB DNA TUMOUR VIRUS MEETING

19
-
24 July 2011

Stazione Marittima Congress Centre

Trieste, Italy


REGISTRATION AND HOTEL RESERVATION FORM

(Closing date for submission: 18 April 2011)

Please n
ote that registration will be accepted only upon receipt of the registration fee.


To be sent by e
-
mail (
dnameeting@quickline.it
) or fax (+39
-
040
-
7606590)

to “Quickline Traduzioni&Congressi”


S
ECTION
A
PERSON
AL DATA


Last name *







First name *







Affiliation *







Nationality







Position
(P.I., postdoc, student… )







Institute / Company







Full work addres
s







City / postal code







Country







Telephone







Fax







E
-
mail






Note: a written confirmation of this reservation will be sent to this e
-
mail addr
ess.

I will submit an abstract YES

NO



(*) Please insert data as you would like it to appear on your personal badge.


Section B
REGISTRATION FEE


Participant



Euro 480,
00

The registration fee includes attendance at the

(after 18/04/11 Euro 520,00)



meeting, book of

abstracts, coffee breaks, lunches,







dinners, and closing banquet.


Accompanying person Euro 260,00
The fee includes dinners and closing banque
t

(after 18/04/11 Euro 300,00 )



Name of accompanying person







S
ECTION
C
H
OTEL
R
ESERVATION


Confirmation of hotel reservation will be sent upon receipt of deposit.


All rates are reserved for ICGEB participants in the m
eeting and are quoted per night,
including breakfast and all taxes.


A deposit of one night’s stay is required for reservation at conference rates. Participants will
pay the remainder directly to the hotel upon checkout.


Return of hotel deposit can only b
e guaranteed upon cancellation BEFORE 18 June 2011



Participant's Name:









Male:

Female:


Check one option only

( the rates are quoted in Euros per room )



Rooms


3 stars Hotel

4 stars Hotel

Single room


85


130

Double room*


115


150

Twin share**


115


150

Double use single


93


130

Hotel preference (first come, first served):







* Name of Accompanying


Person (for double room only):







** Name of preferred room
-
mate (for twin share):







Name of room
-
mate’s Institute / Company:







NB
Unless both room
-
mates specify each
other, they will be allocated on a first come
first served basis.


Date of Arrival









Expected Arrival Time









Date of Departure







Mode of Transport










S
ECTION D
SUMMARY OF PAYMENT
S

Meeting Registration Fee (participant )

Euro






Accompanying person

Euro






Hotel deposit ( minimum one night )

Euro






TOTAL AMOUNT

Euro







Complete refunds cannot be guaranteed for cancellations made after

18 June 2011.

Cancellations before this date will be subject to a handling fee of Euro 50

Method of payment


A) CREDIT CARD Please debit my


Eurocard







Mastercard







Visa


for the amount of Euro:








Name of card holder:







Card number:













Expiry

Date:











B) Direct Bank transfer to:

Benificiary:




QUICKLINE SAS

Bank account number:


000100230804 (Euro)

Bank:




UniCredit Banca Spa

IBAN code:





IT 76 J 02008
02204

000100230804

SWIFT Code
:



UNCRITB1884

(onl
y for foreign bank transfers )


(solo per bonifici italia)

CODICE ABI



02208

CODICE CAB




02204


A copy of the bank transfer document (clearly indicating “No charges to the beneficiary”) must
be attached to this Registration Form and
sent to “ Quickl
ine traduzioni e congressi “ by fax
(fax number 0039 040 7606590 ) or by mail (
dnameeting@quickline.it

)



Last name







First name Mr.

Mrs.









E
-
mail







S
ECTION
E
(DETAILS FOR THE RECEIPT OF PAYMENT)

Please send receipt:






Name/Institute







A
ddress








City









Postal Code








Country








For Italian participants only

Codice Fisc. / P.IVA







S
ECTION
F
(I
TALIAN
P
ARTICIPANTS ONLY
)

Informativa ai sensi de
lla privacy

Autorizzo il trattamento dei miei dati personali ai sensi della legge sulla privacy DLGS
196/2003


Firma per accettazione ________________________________