Registration Form for
from July 11(expected arrival)
to July 17 (expected departure)
to be sent by e_mail to: email@example.com coping and and pasting the followings:
I intend to partecipate in the Stripes 2012 Conference.
- My family name:
- My first name (and initials):
- My affiliation:
- My address:
- My e-mail address:
- My telephone number
- My fax:
- 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) , ,
- I will arrive on: ..............(11 July Expected Arrival),
- I will leave on: ................ ( 17 July Expected Departure)
-I will attend (Select the days you are going to attend):
12 July, 13 July ,14 July, 15 July, 16 July
- Flight details are the followings: _________________________
Registration at Superstripes2012 for
Surname : _____________________
Name : _____________________
I have made the bank transfer
on (date): _____________________, amount: _____________________
Through the bank:
Bank Name : _____________________
Bank address: _____________________