Mobile HCI 2002 Pisa (Italy), September 18 – 20, 2002

REGISTRATION FORM

Please complete the following form, print it, and send it by fax to:

TRE EMME CONGRESSI

Via Risorgimento, 4 - 56126 Pisa, ITALY

Tel: +39 050-44154 / 050-20583; Fax: +39 050-500725

treemme@sirius.pisa.it http://www.treemmecongressi.it

(You can also download this form in pdf format (14 KB))

Title:	Last Name:	First Name:

Affiliation:

Address:

City:		Zip code:
Country:
Telephone:		Fax:
Email:
Invoice to (Only for Italian Participants):
Fiscal Code or VAT Number:

	Student certification: in order to be eligible for the student fee you must provide proof of your enrollment in an Institute of higher learning (university or polytechnic)
	Do not include my name, mailing/e-mail address, phone and fax numbers on the attendee list

Meal requirements:
Vegetarian	Other: (we will notify you if it is possible)

I would like to register for (fee includes VAT 20%):

Workshop (September 17)

Workshop 1: fee = 100 €

Workshop 3: fee = 100 €

Tutorial (September 17)

Tutorial 1, fee = 100 €

Tutorial 2, fee = 100 €

Tutorial 1 AND Tutorial 2, fee = 150 €


Symposium (Sept. 18,19,20)	Early (before 15th June)	Normal (before 26th July)	Late/On Site (After 26th July)
Normal	400 €	450 €	*500 € ^()**
Student	200 €	250 €	300 €
Normal fee includes:	Proceedings, coffee-breaks, welcome cocktail, delegate bag, buses, lunches.
Student fee includes:	Proceedings, coffee-breaks, welcome cocktail, delegate bag, buses.

*^() Please note that the Normal registration to the Symposium has been reduced to 500€ but it DOES NOT INCLUDE the social event (no seats are available anymore).**

N.B. Cancellation made before July 26th are subjected to a 30% cancellation fee. No refund will be done for cancellations communicated after that date. Please note that forms received without payment will not be taken into consideration.

Payment must be made in Euro by one of the following methods:

Bank transfer (only for Registration Fee)

Transfer your TOTAL amount (free of bank charges) to:

For International Bank transfer:

CASSA DI RISPARMIO DI PISA, AG. 1

Corso Italia 4, 56125 Pisa (Italy)

Bank Account(IBAN): IT48 T062 5514 021C C021 0141 208 l

Bank Identifier Code (BIC): CRPIIT31721

For Italian Bank transfer:

CASSA DI RISPARMIO DI PISA, AG. 1

Corso Italia 4, 56125 Pisa (Italy)

Bank Account (BBAN): T 06255 14 021 CC0210141208

Payment should made net of all bank charges.

A copy of the bank transfer s hould be attached to the registration form.

International cheque

N. Bank:

for € payable to TRE EMME CONGRESSI srl

Credit Card

I authorize to be charged to my credit card the amount of €

VISA MASTERCARD EUROCARD CARTASI'

Card Number: Expiry Date: / /

Card Holder (capital letters):

In accordance with the Italian privacy law (n. 675/96) we hereby declare that any personal information in our possession will be used only for the purposes of the organization of the Conference. If you like your name to be included in mailing lists for future announcements of conferences, please sign the declaration below.

I grant permission to the Organizers of the Conference to use my name in mailing lists for future announcements of conferences: YES NO

Place: Date: / / Signature: _______________________


I have read and I accept the above conditions.
Date : / /	Signature :____________________________

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