FREE REGISTRATION FORM – OMCeO

Please return this form within
10th September
to:
Organising Secretariat:

Fax +39 02 76406966

Thirteenth World Conference on The Future of Science

“The Lives to Come”

Fondazione Giorgio Cini, Venezia

21st - 22nd September 2017

Instructions:

Please note that the information below will be reproduced in the conference lists and will be used for all communications. Please type or write in BLOCK LETTERS. Seat availability is limited.

PERSONAL DETAILS

Title (Prof., Dr., Mr., Mrs., Ms., Miss) ......
Family Name ......
First Name ......
Date of birth………………………………………………………………………………………………………………………………
Organisation/Institute/ Company......
Position ......
Address ......
Zip Code and City ......
State/Country ......
Telephone ...... Fax ......
E-mail......

REGISTRATION COVERS:



BADGE AND CONFERENCE KIT: Your badge and Conference Kit can be collected from the Registration Desk at the Fondazione G. Cini beginning on the afternoon of September 21th.

! Please note that badge is the only official evidence of registration and is required to attend all Conference activities.

CONFERENCE PROGRAMME
Please tick X the sessions you plan to attend:
o  Thursday, Sept. 21th
o  Friday, Sept. 22th
SOCIAL EVENTS:
o  Welcome cocktail Thursday, Sept. 21th 7 PM

A written confirmation will be forwarded as soon as your registration has been duly processed.

Please tick X

o  I have been informed that my personal data will be processed by the Umberto Veronesi Foundation as allowed by italian law 196/03 and am aware of my rights under that law. By completing and submitting this form, I give my consent for my personal data to be processed, for the purposes mentioned in the information note available on the website.

o  In accordance with art. 10 cod. civ. and Articles. 96 and 97 of Law 22 April 1941 n. 633 (so-called law on copyright), and subsequent additions and modifications, I authorize Fondazione Umberto Veronesi to the publication, free of charge, of image and/or video footage on any medium (paper, electronic, digital or other) and the use for communication purpose related to the Veronesi Foundation and the Future of Science project. The use and economic exploitation of these occasions are free of charge.

DATE………………………………... SIGNATURE…………………………………………………………….