Iceaa 05 Conference Registration Form

10th IAA SYMPOSIUM ON THE FUTURE OF SPACE EXPLORATION TOWARDS THE MOON VILLAGE AND BEYOND June 27 – 29, 2017 Torino, Italy

Please FILL ALL FIELDS in using CAPITAL LETTERS and return this Registration Form to COREP – Giusy Spinasanta - Email: [email protected] HANDWRITTEN FORMS WILL NOT BE ACCEPTED

Last name______First name ______

Company or organization______

Address______City and Country______Zip______

Telephone ______Telefax ______Email ______

THE INVOICE MUST BE HEADED AND SENT TO THE FOLLOWING ORGANISATION/ADDRESS: The invoice will be delivered upon receipt of the payment fee, NOT BEFORE

Organization/Company ______

V.A.T. number /FISCAL CODE (MANDATORY FOR ALL )______

Address______City and Country______Zip______

FOR THE ITALIAN PUBLIC ORGANIZATIONS PLEASE INDICATE THE CODE EXEMPT VAT _____

With this signature I also permit the use of my personal data for any purpose related to the Congress organization (in compliance with Italian Legislative Decree n. 196/2003).

Signature ______

Registration Fee Registration fees are expressed in Euro. Early registration applicable if payment is received before May 30, 2017

Early Late

Delegates (the fee includes attendance to all sessions, proceeding , welcome party , lunch 450 € 530 € and coffee breaks)

Students (the fee includes attendance to all sessions and coffee breaks) and SGAC members 100 €

Tickets for the official dinner will be available at the registration desk

PAYMENT SHOULD BE MADE EITHER AS:  Bank transfer payable to COREP TORINO on the account no. 4416205 at: UNICREDIT Banca SpA, Ag. 8060 - Via d' Ovidio 6, 10129 Torino, Italy IBAN IT36B0200801160000004416205 - SWIFT CODE and BIC: UNCRITM1AG0 Please make reference to "10th IAA’17 Registration" in bank documents and indicate name of registrant  Credit Card: Secure online registration at the following link: http://www.corep.it/congress_iaa_17.html online Registration with PayPal balance or one of the following credit cards: MasterCard/Eurocard; Visa/Delta/Electron; American Express; Switch/Maestro; Solo