REGISTRATION FORM

Name (Last, First)
Organization
Street Address
City
State
Country
Zip or Postal Code
Telephone
Fax
E-Mail Address

Fees (in Euros): 

Registration (including Wednesday evening reception) Euro 125*

Student registration** (including Wednesday evening reception) Euro 75

Medieval Banquet (Friday evening, see programme for details) Euro 53

Medieval Banquet - Vegetarian Menu (Friday evening, see programme for details) Euro 53

 

          

Total

 

* The reduced early bird fee was only for those registering by February 29, 2008 and is no longer applicable. The field trips are included but not travel by London Transport nor any meals.
**Full-time students must be registered at an accredited academic university and less than 30 years old. Proof of student identity will be required.

.

                    Method of Payment

a) Credit Card
Type of Card     VISA MasterCard EuroCard
I want to register online and here are the details of my credit card:
   Name on Card (print)
   Number
01 02 03 04 05 06 07 08 09 10 11 12 2008 2009 2010 2011 2012 2013 Expiration Date
01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Birthdate (mandatory: month-day-year)
Signature (not needed for online registration):_____________________________

I will mail the details of my card with a printed and signed copy of this form

b) I prefer not to use a credit card and am sending a printed and signed copy of this form with details of my bank draft ___

If you choose option (a) but do not register online, please fax or mail registration forms (including details of your credit card) to:
CESNUR
Via Confienza 19
10121 Torino, Italy
Fax: +39-011-541905

If you select option (b) please mail or fax forms to CESNUR, and send bank drafts to CESNUR PIEMONTE as follows
Name of bank: Deutsche Bank, Via Arcivescovado 7, 10121 Torino, Italy
Account number: 033719
ABI Code: 03104
CAB Code: 01000
IBAN: IT36S0310401000000000033719
SWIFT CODE: DEUT IT MM TOR