ࡱ> NQMckDbjbj4F^\^\GPP,$-PW[X\7q0v 7v v v PH :SCHEDA DI ISCRIZIONE CONVEGNO 25-26/11/2017 REGISTRATION FORM CONGRESS 25-26/11/2017 cognome / last namenome / first nameluogo di nascita  place of birthdata di nascita  date of birthNazione CountryCitt CityIndirizzo / AddressE-mailTelefono cellulare Mobile phoneProfessione ProfessionData e ora di arrivo / Date and time of arrivalAeroporto di / airport of Stazione di / station ofCena / dinner 24.11.2017si / no yes / notData e ora di partenza Date and time of departure aeroporto/airport stazione/station di/of Necessit di trasporto da/per aeroporto o stazione / necessity of shuttle service si / no yes / not(A shuttle service is available from/to the airport or station, on request)Necessit di dieta speciale (specificare) Special dietary needs (please explain) Necessit di traduzione e in quale lingua Translation requested (specify language) Necessit di camera singola The need for a single room si / no yes / notAltre necessit particolari Other needs (please specify)Autorizzo il trattamento dei dati da me forniti con la presente scheda (D.lgs 196/03) I authorize the treatment of my personal data with the present form. TARIFFE/FEES ALLOGGIO/ACCOMODATION: - pernottamento e colazione/bed and breakfast: 28,00 euro - pranzo/lunch: 10,00 euro - cena/dinner: 10,00 euro TRASPORTI/TRANSPORT: per le date del/for the dates 24/11 e/and 26/11 - da e per aeroporto di Fiumicino/from and to Fiumicino airport: 17,00 euro - da e per aeroporto di Ciampino/from and to Ciampino airport: 12,00 euro - da e per stazioni Termini/Tiburtina//from and to Termini/Tiburtina stations: 17,00 euro (per arrivi/partenze in altre date si pu prenotare, ma il taxi applicher la tariffa intera) (Vz @ B ~  * 5 > D N P U ^ k t x y z ȻȻȻȻ}}}}ȱ}}}hjhe1=OJQJ^JhjhmOJQJ^JhjhiQOJQJ^JhjhOLOJQJ^JhjOJQJ^Jhjh#ImOJQJ^Jhjh%OJQJ^Jhjhr5OJQJ^Jhjh%5OJQJ^JhjhOL5OJQJ^J1X $Ifgdu $Ifgdj $ a$gdj$a$gdOL @ B 1((( $IfgdOLkd$$IfTF7\rO+!  t044 lapytjTB b $IfgdOL $Ifgd#Im 1((( $IfgdOLkd$$IfTF7\rO+!  t044 lapytjT (kd$$IfTF7\rO+!  t044 lapytjT $IfgdOL   [kd$$IfTF70rO!U  t 044 lap ytjT $IfgdOL $Ifgdj  6 7 8 9 D;;;; $IfgdOLkd$$IfTF7FrO+!y  t0    44 lapytjT9 : Q j k 1((( $IfgdOLkd$$IfTF7\rO+!  t044 lapytjTk z $IfgdOL $Ifgde1= 1( $IfgdOL $Ifgd#Imkd$$IfTF7\rO+!  t044 lapytjT     & ' , . 0 c d e r  浨樵Ϩܗφφ hjh#ImOJQJ^JmH sH  hjhjOJQJ^JmH sH hjhe1=OJQJ^JhjhOLOJQJ^Jhjh%OJQJ^Jhjh#ImOJQJ^JhjOJQJ^JhjhiQOJQJ^JhjhmOJQJ^J/ (kdy$$IfTF7\rO+!  t044 lapytjT $IfgdOL   ' - . / $$Ifa$gde1= $Ifgde1= $IfgdOL/ 0 e 1((( $Ifgd#Imkdr$$IfTF7\rO+!  t044 lapytjT $Ifgd#Im $Ifgd%  7 8 1((( $Ifgd#Imkdk$$IfTF7\rO+!  t044 lapytjT8 9 c mddd $Ifgd#Imkdd $$IfTF70r+!y  t 044 lap ytjT 9 Q R  _ ` k l ijijĦ⦙s`Q?"hjhr0J5>*OJQJ^Jhj0J5>*OJQJ^J$hjhu0JOJQJ^JmH sH $hjhr0JOJQJ^JmH sH $hjh#Im0JOJQJ^JmH sH hjhsOJQJ^JhjhuOJQJ^J hjh%OJQJ^JmH sH  hjh#ImOJQJ^JmH sH hjh%OJQJ^Jhjh#ImOJQJ^J hjh#ImOJQJ^JmH sH  md[dd $Ifgd% $Ifgd#Imkd $$IfTF70r+!q  t 044 lap ytjT   mddd $Ifgd#Imkd $$IfTF70r+!q  t 044 lap ytjT  l mkkcc[SF -DM gdj$a$gdj$a$gdr$a$gdrkd $$IfTF70r+!q  t 044 lap ytjT GHQ[]luzϾ}jZCjZj,hF2~hF2~>*B*OJQJ^JmH phsH hF2~>*B*OJQJ^Jph$hjhr>*B*OJQJ^JphhF2~5B*OJQJ^Jph$hjhr5B*OJQJ^Jphhj5B*OJQJ^JphhF2~B*OJQJ^Jph!hjhrB*OJQJ^Jphhjhr0J5OJQJ^J"hjhr0J5>*OJQJ^JhF2~0J5>*OJQJ^J,GH]$~kD -DM gdj IiqDADZDhDiDkD˶˴i1h?hrB*CJOJQJ^JaJmH phsH 1h?h?B*CJOJQJ^JaJmH phsH 1h?hF2~B*CJOJQJ^JaJmH phsH U)h?hF2~B*OJQJ^JmH phsH hF2~B*OJQJ^Jph!hjhrB*OJQJ^Jph)hF2~hF2~B*OJQJ^JmH phsH (for arrivals/departures on other dates, one can do the booking, but the taxi will request the full fare) 21h:p". 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