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Registration Form (Eng)
ANEP CONGRESS REGISTRATION FORM
PARMA, MAY 24-25 2008 THE PRENATAL EXPERIENCE WITHIN
NEUROSCIENCES, MEDICINE, PSYCHOLOGY AND EDUCATION
 

Registration form must be accompanied by payment
Students must enclose a photocopy of their University
Matriculation book.


PAYMENT METHODS:
• With VISA Credit Card;
• By bank transfer:
Bank transfer, free of bank charges, to Parma Incoming bank account
nr. 000035511088 at Cassa di Risparmio di Parma e Piacenza
Agenzia 10 - ABI 06230 - CAB 12710 - CIN G
IBAN IT97 G062 3012 7100 0003 5511 088 (Enclose a copy of the Bank
Transfer) SWIFT CODE CRPPIT2P449
ANEP CONGRESS REGISTRATION FORM


Registration Fee (Euros)

€ 80.00+italian V.A.T.  20% TOTAL (VAT INCLUSIVE) € 96 (student)
€ 240.00+italian V.A.T. 20% TOTAL (VAT INCLUSIVE) € 288 (non-student)


Send to: to be returned by fax - Fax: +39 0521/298826

 

First Name and Surname:
  *
Company:
Bill to:
Fiscal data (CIF or ISO code):
Department/mail stop:
Address:
  *
City/Town:
  *
Postal Code:
Country:
  *
Tel.:
  *
Fax:
E-mail:
  *
Credit Card (only VISA):
Number:
Name as printed on card:
Expiration:
I authorize you to charge my credit card for €:
* Campo richiesto

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