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REGISTRATION FORM

  1. Personal details

  2. Title
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  3. Family name
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  4. First name
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  5. Accompanying person
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  6. Organization
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  7. Full address
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  8. Zip code
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  9. Country
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  10. Phone
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  11. Fax
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  12. Email address
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  13. Email address verification
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  14. Registration details

  15. Please select the appropriate option
  16. Registration fee participant
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  17. Registration fee accompanying person
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  19. (*) students must enclose to this form a valid certificate of their status.

  20. Social events

  21. please tick all of the appropriate buttons
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  27. Payment instructions

  28. Payment option


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  29. (**) note that the bank transfer payment must be made with no costs to the beneficiary
  30. In accordance with the Italian Privacy Law (Law 196/03), I hereby authorise NEXA sas to use my personal details to process my registration. I may have access to these details at any time and request their modification and cancellation.
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  32.