Eurohaptics 2018 Registration

PERSONAL DATA

Last Name* First Name*
Gender*
Address* Postal Code*
Town* Country*
Date of birth* [YYYY-MM-DD] City of birth*
Country of birth*
C.F. (Fiscal code for Italian participant) Phone*
Email address* Fax
Paper/Submission ID

AFFILIATION

Department* University/Company*
Affiliation Address* Affiliation Postal Code*
Affiliation Town* Affiliation Country*
I need an invoice addressed to a different subject

if you need an invoice addressed to a different subject (department, university or other institution) please check the box and fill in the following section

INVOICE DETAIL

** compulsory field if the invoice is addressed to a different subject

University/Company Name**
University/Company Address** University/Company Postal Code**
University/Company Town** University/Company Country**
University/Company VAT number**

REGISTRATION FEE

Early registration expired on April 15th, 2018


1 - For PhD and Master students: a copy of the certificate of enrollment in a PhD or Master Degree programme must be submitted in one single PDF document through an e-mail to registration@eurohaptics2018.org. The subject line of the e-mail must be “PhD/Master STUDENT REGISTRATION FOR EH 2018 Surname-Name-Country”. .

FOOD PREFERENCES

non veganvegan
non celiacceliac

METHOD OF PAYMENT

Method*

Credit card
*** compulsory field if credit card is the selcted payment method
I hereby authorize A.I.C. srl to charge on my credit card


Type of credit card***
VISAMastercard

Amount*** Card Number***
Exp. Date*** CVV Code***

insert month and year expiration date

CVV code: last 3 numbers behind your credit card
Cardholder***

Bank transfer addressed to:

Asti Incentives & Congressi srl
c/o Monte dei Paschi di Siena, Ag. 1 Pisa - Lungarno A. Pacinotti 56124 Pisa, Italy
C/C IBAN IT95D0103014000000002084433
Swift/Bic Code: PASCITMMPIS
Reference: EUROHAPTICS + "University/Company name"
Please send a copy of bank transfer to registration@eurohaptics2018.org


ACCOMODATION

To book your accomodation at preferential rates for Eurohaptics 2018 go to this link.

For info about accomodation visit the accomodation page

Authorization to the treatment of personal data*
Yes
I hereby authorize A.I.C srl to the treatment of my personal data for all the aims related to the above mentioned congress and according to the law D.Lgs. 196/2003

* compulsory field



Administrative Secretary
Asti Incentives & Congressi srl
P.zza S. Uomobono, 30
56126 Pisa
Ph. (+39) 050 598.808
www.aicgroup.it