11TH ICA 2018

SPECIAL IRS“2DAYS RAGWEED PACKAGE”- WORKSHOP REGISTRATION FORM

Please send this form filled and signed to:

PARTICIPANT Prof./Dr./Mr./Mrs.

Surname______First name______

Sex □ M □ F Birth date______State (city if Italian)______

Affiliation______(ex., "University of London" or "Private Practice”)

Address______

ZIP Code ______City______County/Province______

State______Mobile______

Phone______Fax______

E-mail______@______

Please invoice to:

Invoice Header______

Address______

Zip code______Town ______Country______

Vat number 

Fiscal code  (compulsory only for Italian participants)

Please send the invoice by e-mailto ______@______

No invoice will be issued in case of missing or unreadable data. No invoice will be re-issued or modified in the heading details in case of mistake or incomplete data by the participant.

REGISTRATION FEES in Euro VAT RATE CALCULATED AT CURRENT TAXATION UPON PAYMENT SETTLEMENT – at present 22%

Early registration: 2018 within May 15th - €220,00 + VAT 22% = € 268,40

Late Registration: 2018 within June 15th - € 280,00 + VAT 22% = € 341,60

EXTRA FEE UPON AVAILABILITY

Conference Visit and Social Dinner (WEDNESDAY evening) € 100,00, per person (VAT 10% included) – onsite not available

ICA Food Valley visit (FRIDAY afternoon) € 75,00, per person (VAT 22% included) -- onsite not available

□gluten free □vegetarian □ any other food intolerance ______

Special IRS “2days ragweed package” registration fees includes: Participation in the scientific sessions as per program, Opening Ceremony and Welcome reception, light sandwich lunch on Monday and lunch on Tuesday as per ICA Congress program, Abstract book and Final Program of the congress and materials. Please note that the Conference Visit and Social Dinner (WEDNESDAY evening) and ICA Food Valley visit (FRIDAY afternoon) are not included in the registration fee and have to be added.

PAYMENT

The payment for a TOTAL of ...... Euro is made by:

□CREDIT CARD

I authorize the charge of € ______for the registration fee on the following credit card:  VISA  Mastercard

Card Holder______n° 

Expiry date ______/______CV2 code ______(indicated in the back side of the card and corresponds to the three last numbers in the space of the holder signature)

Date______Signature______

□BANK TRANSFER

PAYMENT TO BE SETTLED WITHIN THE END OF THE PROPER DEADLINE (please check registration categories and relevant deadlines in the table above).

If you decide to pay by transfer please see details and information below:

ACCOUNT holder: MV Congressi Spa

BANK NAME: CARISBO Ag. Via Massimo D'Azeglio 29/C, Parma

BIC/SWIFT code: IBSPIT2B

IBAN code: IT32R0638512731100000000613

Object: participant's name, surname and code 1901 clearly indicated on the bank payment.

IT’ IS COMPULSORY TO SEND A PHOTOCOPY OF THE PROCESSED BANK TRANSFER BY E-MAIL:

CANCELLATION AND REFUND POLICY FOR REGISTRATION

Cancellation can only be made in writing to the Organising Secretariat (MV Congressi Spa).

– Cancellation received within June 15th 2018: 70% refund.

– Cancellation received after June 15th 2018 or no notice: no refund.

If for reasons beyond the control of the Organisers the Congress is cancelled, registration fees will be refunded following deduction of unavoidable expenses. No refund will be given in case of no-show, late arrival, unused services, unattended events or early termination of attendance. In case of regular registration and missed participation, the Organising Secretariat will send the conference abstract book upon request of the registered participant. The forwarding of the abstract book will invalidate each claim for reimbursement.

All refunds will be processed after the event

Pursuant Information On Law 196/2003

MV Congressi s.p.a , as data controller and/or processor, informs you that any personal data you provide, or any data received by third parties, will be used in connection to your participation to the Congress and/or to provide you with information regarding any other compatible activities organized by MV Congressi s.p.a. Data treatment shall mean any operation, or set of operations, carried out with or without the help of electronic or automated means, and must guarantee the confidentiality and security of your personal data. MV Congressi s.p.a, as data controller and/or processor may avail itself to carry out any of the following procedures: press releases, communications to clients, data processing and computer-based consultation. The data can be communicated to scientific associations, relative public or private agencies related to CME, financial and banking intermediaries, as well as companies participating in the Congress with promotional functions compatible with the purposes for which the data has been collected. The provision of your personal data is voluntary, but refusal will prevent your participation to the Congress. Under section 7 of the Legislative Decree no. 196 of 30 June 2003 you have the right to object to the processing of your personal data for the purposes relevant to the collection, for purposes of sending advertising materials or direct selling or else for the performance of market or commercial communication surveys. Any requests can be addressed to: MV Congressi s.p.a - Via Marchesi 26d- 43126 Parma

I authorize the treatment and communication of my personal data as described above.

Date ______- Signature______

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