REGISTRATION FORM

Please TYPE all informationand
send the Registration Form together with the receipt of payment
to the Conference Secretariat:

SECTION 1: PERSONAL DETAILS

Title (Dr/Prof./Mr/Ms/Mrs/Other) Family Name Given Name _

IEEE MEMBER # Organisation _

Position _ Address _

City State Country Postcode _

VAT number / Fiscal Code/Tax Id ______

Telephone Fax Mobile _

Email Special Disability / Dietary Requirements _

I permit the use of my personal data for any purpose related to the Congress organization (in compliance with Italian Legislative Decree n. 196/2003).

SECTION 2: PAPER(S) DETAILS

All papers must be presented by one of the authors and each registered author may present no more than two papers - these can be in the same Conference (ICEAA, or APWC), or distributed over both Conferences.The second paper presented by the same author incurs an additional fee of 45 EU. Please refer to the website for details

ICEAA - IEEE APWC 2017 requires registration for every paper to be scheduled for presentation and published in the Conference proceedings. The non-refundable registration fee of the presenting author is required by June 9, 2017 (at the time of the submission of the contribution in final form).

Registration for:

PAPER NUMBER: ______

PAPER NUMBER: ______

Final paper(s) converted or checked by using IEEE PDF eXpress:  YES NO

SECTION 3: CONFERENCE REGISTRATION / TAX INVOICE (All fees are quoted in Euro, VAT included)

Please indicate registration category by ticking the appropriate box:

ConferenceRegistration Fee for Presenting Author Mandatory registration is due

on or before June 9, 2017

Presenting 1 paper  EU 690

Presenting 1 paper - IEEE Member * EU 670

Presenting 2 papers EU 735

Presenting 2 papers - IEEE Member * EU 715

Conference Registration Fee for non Author on or before June 9, 2017after June 9, 2017

Delegate EU 690  EU 715

IEEE Member * EU 670  EU 695

Accompanying Person** EU 120  EU 120

*IEEE Member must provide IEEE Member Number in Section 1

**The accompanying person fee includes the Gala Dinner only.

TOTAL AMOUNT SECTION 3EU ______

Registrations will be considered as confirmed only upon receipt of the payment.

THE INVOICE MUST BE HEADED AND SENT TO THE FOLLOWING ORGANISATION/ADDRESS:

(if different from the Personal Details provided in Section 1)

Organisation/Company ______

VAT number / Fiscal Code ______

Address ______City ______

Zip ______Country ______

Email ______

The invoice will be delivered upon receipt of the payment fee, NOT BEFORE

SECTION 4: SUMMARY OF PAYMENTS

TOTAL PAYMENT TO BE CHARGEDEU______

All payments are to be made in EURO(bank expenses on your charge)

PAYMENT SHOULD BE MADE EITHER AS:

Secure online registration at the following link:

with credit cards: Mastercard, Visa, or Diners/Discover

Bank transfer payable to:

SELENE Srl on the account no. 64643 – Intesa Sanpaolo

Bank code: ABI 03069 CAB 01048 CIN H

IBAN: IT95H0306901048100000064643

BIC: BCITITMM

Please make reference to "ICEAA - IEEE APWC 2017 Registration" and state your name and surname on bank documents. Payments via bank transfer can only be accepted upon receipt of proof of payment.

Please send the Registration Form and the receipt of payment to the Conference Secretariat:

SELENE Srl - Email: - Fax: +39 (0)11 7499576

______

SECTION 5: CONFERENCE COURSES

Some optional Short Courses on topics of contemporary importance in electromagnetics and its applications are being arranged. Further details will be available later on the conference website.

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CANCELLATION POLICY FOR REGISTRATION

Registration fees for presenting authors (due by 9th June 2017) are not refundable.

All other cancellations must be notified in writing to the Conference Secretariat. Cancellations received prior to 30th June 2017 will receive a full refund less EU 100 administration fee. Should you cancel after 30th June 2017 you will receive a 50% refund less EU 100 administration fee. Cancellations received on or after 11th August 2017 will not be refunded.

DISCLAIMER OF LIABILITY

The Conference Organizers will not accept liability for personal injury or loss/damage to property/belongings of participants or accompanying persons, and occurring before, during or following the conference and its associated tours, or their stay in Italy. It is therefore recommended that participants and accompanying persons arrange for their own personal health, accident and travel insurance.

ITALIAN PRIVACY LAW (Italian Legislative Decree n° 196/2003)

Your personal data will be processed in compliance with the Italian Legislative Decree n° 196/2003 and will be used for circulation within the company for administrative and counting activities. The data may be transmitted to external bodies which perform functions strictly connected and instrumental to service operations. Please visit SELENE Srl website for detailed information on Personal Data Treatment:

Date ______Signature ______

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CONFERENCE SECRETARIAT

SELENE SRL
Via G. Medici 23 - 10143 Torino (ITALY) - Tel. +39 (0) 11 7499601 - Fax 39 (0) 11 7499576
Email:

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