DHEAL-COM PHD SCHOOL PAVIA-REGISTRATION FORM

DHEAL-COM INTERNATIONAL PHD SCHOOL PAVIA - REGISTRATION FORM

(*compulsory data)
Name*

Name (and second name)Family name/Surname
E-mail*
exemple@exemple.com
Mobile Number
Institution/University*
Country*
DIETARY REQUIREMENTS

(allergies, intollerancies, special dietary...)
Dietary requirements*

YesNo
Kindly let us know your dietary restricion?*

VegetarianPescatarianVeganHalalKosherGluten-freeFood AllergyIntollerancesNone
INTOLLERANCIES*

GlutenLactoseOther
ALLERGIES*

PeanutsShellfishEggsFishSoyMilkTree NutsMushroomsMustardOther
NOTES. For severe symptoms please specify your symptoms or special needs. (If available bring with you your Food Allergy & Anaphylaxis Emergency Care Plan)
FEES

Registration - PhD Student	250,00 €
Registration - PhD Student hired on DHEAL-COM project (free registration after verification)	0,00 €
Registration - NON PhD Student**	250,00 €

PLEASE NOTE:

VAT 22% is included
Fees include: attendance to all sessions, coffee breaks, lunches, social dinner and young party dinner
**Priority will be given to PhD students. NON PhD students can register to join the waiting list. They will be notified whether the application has been accepted or not.

I register as:

PhD StudentPhD Student (hired on DHEAL-COM project)NON PhD Student (WAITING LIST)
Please upload here a proof of your PhD student status*

Cancelof
Please upload here a proof of your DHEAL Covered registration*

Cancelof
INVOICING DETAILS

Invoice will be sent after payment, by e-mail, prior to the school. Contact us for any issues: eventi@pragmacongressi.it
Type of Invoice*

Invoice to PERSONInvoice to COMPANY
Invoice to Person*

Name - Last Name

Address

City

Zip Code
Fiscal Code*
Invoice to Company/Institution*

Company/Institution name

Address

City

Zip CodeCountry
VAT Number
VAT Number (for EU) or tax code identification number - VAT is mandatory for EU institutions/companies
Codice SDI
CODICE SDI per fattura elettronica (ONLY FOR ITALIAN COMPANIES/INSTITUTIONS)

PAYMENT
I will pay by*

Credit Card (you'll be directed at the credit card payment page after reviewing and sending the form)Bank Transfer
Please select the fee*
prevnext( X )
REGISTRATION FEE
€250.00

Total

€0.00
Bank transfer of 250,00 € (in Euros, net of any bank charges) to:

Beneficiary: Pragma Congressi
Bank : BPER
IBAN: IT77H0538711301000046083796
SWIFT: BPMOIT22

Every bank transfer must mention DHEAL-COM PAVIA as well as the name of the participant
Any purchase order must mention DHEAL-COM PAVIA as well as the name of the participant

*FOR PAYMENTS MADE BY ITALIAN PUBLIC INSTITUTIONS: PLEASE CONTACT US BEFORE PAYING THE FEE eventi@pragmacongressi.it *
CANCELLATION POLICY:

A €50 administrative fee will be assessed on all cancellations. Confirmed registrants who do not attend the conference or who cancel after January 22nd are responsible for the entire registration fee.
Notes
DATA PROCESSING AUTHORIZATION
Should be Empty:

DHEAL-COM INTERNATIONAL PHD SCHOOL PAVIA - REGISTRATION FORM