BILLING DETAILS FORM SURNAMECOMPANY NAME NAME

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BILLING DETAILS FORM SURNAMECOMPANY NAME NAME

BILLING DETAILS FORM

Surname/Company name

Name

VAT number

Tax code

Address

Postcode City

Country tel

e-mail

Registration fees

€ 120 for author presenting poster or oral contribution

€ 100 attendance fee for congress participants

Free access to students

After April 15^th 2012 the fee is 120 euros for all participants, except the students.

The registration fees are 21% VAT included.

Payment can be made to

MAP SERVICE srl

Via Bologna12/1a, 43122 Parma (Italy)

VAT number and Tax code 01966240341

The payment can be made:

By bank transfer order to:

Unicredit Banca Spa – Agenzia N. 3387

Piazza Caduti del Lavoro 11, 43126 Parma, (Italy)

IBAN : IT 69 Q 02008 12702 000101871283
BIC (SWIFT code): UNCRITM1PU7
code name “your name + EUREGEO2012 –

In cash in € (euro) at the Congress reception desk, from 12^th to the 15^th of June, 2012

Indications

The Billing details form has to be completed and returned to the MAP Service s.r.l. together with proof of payment of registration fee by FAX no. +39 051 5280042 or by e-mail to [email protected]

The registration is only valid upon receipt of communication of payment made.

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