/ 7th Intl Conference on
Vibration Measurements by Laser Techniques
& Short Course
Ancona, 19-22 June 2006

Supported by the EUROPEAN COMMISSION, Research DG, The human factor,
mobility and Marie Curie activities Marie Curie Conferences & Training Courses- Series of Events (SCF)

REGISTRATION FORM for FUNDED PARTICIPANTS

Please return to: A.I.VE.LA. Conference Secretariat

fax: +39 071 2204813

WORKPLACE INFORMATION / HOME INFORMATION
Title
First Name
Surname
Company
Section
Address / Address
Post code/City / Post code/ City
Country / Country
Telephone / Telephone
Fax / Fax
E-mail / E-mail
Directly charged to the funds of the project MSCF-CT-2003-504127 / Charged to the researcher
I intend to participate in the Short Course, 19 June / ◊ 324,18 / ◊ 25,82 € for membership fee
Directly charged to the funds of the project MSCF-CT-2003-504127 / Charged to the researcher
I intend to participate in the Conference, 20-22 June / ◊ 524,18 / ◊ 25,82 € for membership fee
Directly charged to the funds of the project MSCF-CT-2003-504127 / Charged to the researcher
I intend to participate in the Short Course and in the Conference / ◊ 754,18 / ◊ 25,82 € for membership fee

PAYMENT - tick as appropriate

◊ Bank transfer to AIVELA - Account N°: 5926.5.44 - c/o UNICREDIT BANCA, Ag.via Tavernelle, 60131 Ancona, Italia, IBAN: IT 11 C 2008 02607 000005926544 on date ……………………………………………- Please send a proof of payment

◊ Crossed Cheque payable to AIVELA

◊ Cash at the Conference Registration desk

INFORMATION AND CONSENT TO THE TREATMENT OF PERSONAL DATA

(art.13 Decree-law n°196/2003)

We wish to inform you that your personal data will be collected by us with the only purpose of carrying out our institutional activity and of supplying you the services you asked us for; sensitive data will not be collected; your data will be recorded according to the laws in force and will not be widespread.

Your rights are the ones described in art.7 of Decree-Law n° 196/2003 and they can be exercised with an informal request addressed to A.I.VE.LA, Italian Association of LAser VElocimetry, Via Brecce Bianche n°1, 60131 Ancona.

Date / Signature