<p> 10th IAA SYMPOSIUM ON THE FUTURE OF SPACE EXPLORATION TOWARDS THE MOON VILLAGE AND BEYOND June 27 – 29, 2017 Torino, Italy</p><p>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 </p><p>Last name______First name ______</p><p>Company or organization______</p><p>Address______City and Country______Zip______</p><p>Telephone ______Telefax ______Email ______</p><p>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</p><p>Organization/Company ______</p><p>V.A.T. number /FISCAL CODE (MANDATORY FOR ALL )______</p><p>Address______City and Country______Zip______</p><p>FOR THE ITALIAN PUBLIC ORGANIZATIONS PLEASE INDICATE THE CODE EXEMPT VAT _____</p><p>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).</p><p>Signature ______</p><p>Registration Fee Registration fees are expressed in Euro. Early registration applicable if payment is received before May 30, 2017</p><p>Early Late</p><p>Delegates (the fee includes attendance to all sessions, proceeding , welcome party , lunch 450 € 530 € and coffee breaks)</p><p>Students (the fee includes attendance to all sessions and coffee breaks) and SGAC members 100 € </p><p>Tickets for the official dinner will be available at the registration desk</p><p>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</p>