Registration Form – IWBLD.ORG

Please fill in all the fields below and click submit to send your registration to the organizing committee. You will receive a confirmation email and will be contacted directly from our staff to help you complete your registration

* indicates required field

Attendee

First Name:*

Last Name:*

Department:*

Organization:*

Postal Address:*

City:*

ZIP Code:*

Country:*

Email:*

Phone:*

Registration Type*

Normal rate: 170 € until 15 April 2014
Normal rate: 200 € from 15 April 2014
Students (official certificate required): 80 €
Accompanying Person: 50 €

Accommodation and Conference dinner are not included in the registration fees.
As for the treatment of the participants’ personal data according to the Italian Law 196/2003, all the data provided will be treated for the sole purposes related to the services required.

CAPTCHA Code:*

Payment details

Payments (in Euro) must be done via bank transfer to:

Bank name CARIPARMA – Cassa di Risparmio di Parma e Piacenza, Fiorenzuola d’Arda

Beneficiary IWBLD organizing committee

c/o CRA-Genomics Reserach Centre

via San Protaso 302

29017 Fiorenzuola d’Arda (Italy)

IBAN Code IT68P0623065310000030799474

BIC/SWIFT Code CRPPIT2P020

Causal: Please write “Registration to IWBLD” followed by your Full Name