EuCheMs
School on “ Synthesis and Characterization of Novel Nano-Sized Inorganic Materials”
17-22 June, 2012
Department of Chemistry, Campus Universitario, Bari
Registration Form for PhD, Post Docs, or Industrial staff
Please fill-in this form and send it back by e-mail to: materials.circc@uniba.it within March
31th, 2012 at latest
Name ______________________ Surname ___________________
Male
Female
Date and place of birth ____________________________________________________
Academia
Industry
Academic Institution
____________________________________________________
Company
____________________________________________________
Registration fee Member of National Chemical Societies 500 €* half-board
Non-Member of National Chemical Societies 550 €* half-board
Industry 600 €* half-board
*Accommodation in two-bed rooms
Roommate
Name____________________________________________
Supplement for the single room: 20 € per day per person: total_____ €
Personal request:_________________________________________________________
Vegetarian
Smoking room
Total amount due:
Yes
Yes


No
No


____________________________________________________
Mode of Payment:
* Bank Transfer to the Bank Account IBAN:
IT09 T010 1004 0021 0000 0002 835
BIC/SWIFT:
IBSPITNA
NOWATECH Ass-School EuCheMs
I will present a poster
I will deliver a 5 min flash oral presentation
Title: ………………………………………………………………………………
Authors: underline the name of the presenting author
Institution:
___________________________________________________________________
Company:
___________________________________________________________________
Address:
___________________________________________________________________
I will arrive in Bari on June _________ at ________and leave on____________________________
at____
Participants are expected to arrive in Bari on June 17, 2012 and leave on June 22.
Any extra day will be calculated at 68 € per day half board or 55 € per day bed and breakfast.
Deadlines:
April 5th- April 30th, 2012
March 1st- March 31th, 2012
June 17, 2012
Payment of fee
Copy of abstract
Copy of slides at the registration desk