Registration Form

The conference starts on  June 13th, at 15:00h,  and ends on June 18th  2015 at 13:30h

to be sent by e_mail to:  This email address is being protected from spambots. You need JavaScript enabled to view it. coping and and pasting the followings:

 __________________________

I intend to partecipate in the Superstripes 2015 Conference.

   - My family name:
   - My first name (and initials):
   - My affiliation:
   - My address:
   - My e-mail address:
   - My telephone number
   - My fax:
   - Age:
   - Nationality:

- Select the Academic qualification, (present position):
   I am just starting, I am not even yet a PhD student.
   I am a PhD student.
   I am a postdoctoral fellow.
   I am a faculty member and/or a senior researcher.

- I will submit an abstract   for:
   (Select one of the followings) invited talk, oral contribution, poster contribution

- I will arrive on:  ...............

- I will leave on: ................

- I will attend (Select the days you are going to attend):

  13 June ,14 June, 15 June, 16 June, 17 June,18 June,

- Flight details are the followings: _________________________

_________

Registration at Superstripes2015 for

Surname      : _____________________
Name            : _____________________

I have made the bank transfer

on (date): _____________________, amount: _____________________

Through the bank:
Bank Name    : _____________________
Bank address: _____________________