ssdev - EventRegistration

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Torre del Falasco Prize

Application Form SSDEV2019

To apply please fill out the following form, make sure you select the payment options and click on "submit" at the end of this page.
Remember to submit the required documents (cv, ...) by clicking on the specified link that appears subsequently.
Before paying, wait for acceptance of your application via e-mail. For any question, send an e-mail to ssdev2019@dse.univr.it.
Application deadline is May 10, 2019 at 24:00. All fields marked with an * are mandatory. Use "info buttons" for field explanation.

Gender:*

Title:*

First Name:*

Last name:*

University/Institution:*

Address:*

City:*

Country:*

Postal ZIP Code:*

Telephone:

Fax:

Email:*

Note:

TOTAL PRICE

Options:

		faculty fee	650EUR
		graduate student / post-doc fee	500EUR
		* the above data is truthful and I authorize the use according to the privacy policy
		I agree to get emails about future events in the same field (Verona Winter school, Summer school, ...)
		I do NOT agree to get emails about future events in the same field (Verona Winter school, Summer school, ...)

Receipt

The receipt will be handed out to you during the event.

Below you can see what will be printed on it, according to what you inserted on the registration form. Change the fields according to your needs. You can also specify the VAT number of your institution and/or the italian fiscal number (codice fiscale) if needed.

The receipt will only display the total amount paid. If you need a different receipt please specify it in the note or contact ssdev2019@dse.univr.it.

Line1 (To whom):

Line2 (Institution):

Line3 (Address):

Line4 (Country, Zip, City):

Line5 (VAT number:

+ Italian fiscal number:)

Note: