CISAP-2
2nd International Conference on
Safety & Environment in Process Industry


REGISTRATION FORM

Registration fee includes:
Attendance to the Scientific Sessions
Conference facilities
Proceedings
Welcome cocktail, coffee breaks; 3 lunches, 1 gala dinner

Note! At least one Author per paper has to register before March 31, 2006 to prevent the contribution being withdrawn from the Proceedings and the Final Program.

Date
Surname
First name
Academic Title
Organization
VAT number
(for invoicing)
Street or POBox
Town incl.Zip
Country
telephone
fax
e-mail

Fees ( 20% taxes included) Price Number Total
Registration payment* before March 31, 2006 540 EUR
Registration payment* after March 31, 2006 600 EUR
In addition to the items included in the fee I would like to buy:
extra lunch
(for accompanying persons)		 30 EUR
extra gala dinner
(for accompanying persons)		 100 EUR
  Total paid

* The submission of this form becomes a valid registration only at the receipt of the fee payment. All payments made after March 31 2006 should be of Euro 600.
The registration is valid for the participation of one author and the presentation of one paper.

I am settling my payments by the following way (tick as appropriate):

Cheque made payable to "AIDIC Servizi S.r.l." (please send to address of CISAP-2 Secretariat)

Bank transfer to:
AIDIC Servizi S.r.l.
(bank name and agency number) BANCA INTESA, Ag. 59,
(address) Via CELORIA 2, I-20133 Milano, Italy
(bank coordinates) CIN M ABI 3069 CAB 01749 ACCOUNT 000011154138
Please make sure that your bank transfer charges are not deducted from the total payment required.
Please indicate in the transfer form the name of the participant and the company.
Credit Card
Type of Credit Card

Credit Card No
(16 digits)
Card expiration date
Card holder

Cancellations before May 2nd, 2006 will be charged by 20% costs. We regret to inform that cancellations after May 2nd will not be refunded.