CONFERENCE REGISTRATION FORM – HAHA2002

PLEASE SEND FORM AND REMITTANCE TO:
HAHA2002 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	__________________________________________________________________________
	__________________________________________________________________________________________

	
		
Regular		q 	180 EUROS			

Student *		q  	100 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 – HAHA2002.
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.