MAD on Summer Registration Form

MAD on Summer Registration Form

MAD on Summer Registration Form
Full name*

First NameLast Name
Institution / Affiliation*
Email*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Billing Address
Invoice Header (Name or Institution for Invoice)*
Street Address*
Postal Code*
City*
Country*
VAT Number (if available)
Codice Fiscale (mandatory only for Italians)*
Codice Destinatario / Ufficio / PEC (if available, only for Italians)*
Dietary requirements*

YesNo
Please list any allergy, intolerance, or special dietary requests
The registration includes:
- Lecture notes
- 3 lunches
- 1 welcome cocktail
- 1 social dinner
- 6 coffee break
Payment Method*
Select Registration Fee
prevnext( X )
Early registration (until May 15th)
€270,00

Total

€0,00
Please complete the payment using the following bank details:

Bank: Banca Passadore & C.
Branch: Via E. Vernazza 27, 16121 Genova – Italy
Account Holder: EtaGamma srl
IBAN: IT50 I 03332 01400 000000946826
SWIFT/BIC: PASBITGG
Payment reference: MAD Summer School + Full Name

Once the transfer has been completed, please send a copy of the payment receipt to segreteria@etagamma.it to finalize your registration.
Should be Empty: