PLEASE COMPLETE THE FOLLOWING FORM AND FAX IT AT **39-06-36733347

Click here for printable version of the form (file .doc)

Personal Details:

Person Attending:
Title and Company or Institution:	_____________________________________
Address:	_____________________________________ _____________________________________ _____________________________________
Fax Number and e-mail address:	____________________________________

Conference Fees:

Registration Fee: (includes lunches and coffee breaks)	100 Euros (by 15 May) 130 Euros (after 15 May)
Social Dinner:	60 Euros
Saturday Trip to Adrian's Villa in Tivoli:	20 Euros (per person)       No. of Adults: ____=____Euros
Total:	____Euros

Method of Payment:

Please pay by bank transfer into the following account:
Account Name: ISTITUTO UNIVERSITARIO DI SCIENZE MOTORIE (IUSM)
Bank: BANCA NAZIONALE DEL LAVORO
ACCOUNT NO: 218700; ABI: 1005; CAB: 3309
PLEASE MAKE SURE YOU INDICATE THE REFERENCE "LLC CONFERENCE" WITH YOUR PAYMENT.
We regret we cannot accept any other form of payment.