Registration check-out form

View your registration options “Late registration – AiIG junior members (after June the 30th):” has been selected as your registration.

Registration details

First Name *

Last Name *

Email Address *

Phone *

Country *

Address *

Town / City *

Province *

Postcode / ZIP *

By filling the form the user authorizes the event organizers to manage his/her personal data according to Italian laws (ref. law art. 7 and 13 of D.Lgs. 196/2003). *

Receipt details (to fill in only if different from the registration ones)

First Name *

Last Name *

Company Name

Country *

Address *

Town / City *

Province *

Postcode / ZIP *

Notes

Information about your PhD

University *

PhD Cycle *

PhD Year *

PhD Thesis Title *

PhD Research Field *

PhD Research Keyword 1 *

PhD Research Keyword 2 *

PhD Research Keyword 3 *

Your registration

Product	Total
Late registration - AiIG junior members (after June the 30th): × 1	500,00€
Subtotal	500,00€
Shipping	Shipping costs will be calculated once you have provided your address.
Total	500,00€

Credit card payment

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