CONFERENCE REGISTRATION FORM – AH2000

PLEASE SEND FORM AND REMITTANCE TO:
AH2000 SECRETARIAT
Istituto Trentino di Cultura (ITC), Via S. Croce 77, 38100 TRENTO – ITALY
by fax: ++39–0461-980436 or regular mail.

Type or print in BLOCK LETTERS
First Name 	_______________________________ Last Name _____________________________________
Affiliation ________________________________________________________________________________
Address (Zip Code/City/Country)__________________________________________________________
	__________________________________________________________________________________________
Phone number _	_____________________________ Fax No. _____________________________________
E-mail 	___________________________________________________________________________________
Special requests ________	__________________________________________________________________
	__________________________________________________________________________________________

AH2000	
		
	Before July 20th, 2000	After July 20th, 2000

Regular	q 	300 EUROS	q 	450 EUROS		

Student *	q  	150 EUROS	q 	200 EUROS		

*	Students must send legible proof of full-time student status.

PAYMENT

TOTAL AMOUNT: _____________________________________ EUROS

Without charges for the beneficiary, to the order of ITC, Istituto Trentino di Cultura – AH2000.
Please indicate the method you are using:
q	Bank Transfer**
q	International Check (payable to ITC. Personal/private checks are not acceptable)
q	Authorise charge of my credit card: (VISA, MasterCard, American Express)***
Card Type 	_________________________________________________________________
Expiration Date	 _____________________________________________________________
Credit Card Number 	________________________________________________________
Name as it appears on card ________________________________________________
Signature __________________________________________________________________

** Bank transfer to CARITRO Bank- Sede di Trento, Via Galilei 1, Account n. 6190/TES (ITC), ABI 6330 - CAB 1800 (Caritro Bank swift code CRTNIT2T) should be made net of all bank charges and commission. A copy of the bank transfer order should be postmarked or faxed together with the registration form.

*** Registration and payment made by Credit Card must be sent duly signed, by fax or regular mail, otherwise will not be accepted.

In accordance with Law no. 675/96 we hereby declare that any personal information in our possession will be used only for the purposes of the conference.