The fields in red are obligatory.  
Personal Information
Title:
 Name:
 Surname:
Gender:
 Email:
 Phone:
Web Page:
 Fax:
 
Affiliation
Position:
 University - Institute:
 Department:
Postal Code:
 Street / P.O. Box:
 City:
Country:
 
Contribution Paper and Talk
 I plan to give a talk with the following title:
    
 Sending the summary following this form   
 I'am attaching the LaTeX file of my abstract for the talk
    
 I will send the LaTeX file of my abstract for the talk later by e-mail (to the address)
    thermocon16@unime.it
 
Registration fee
Professor and Doctor will pay the registration fee for the amount of € 150 until January 31th and for the amount of € 200 after January 31th   €  
PhD Student or other position € 50   €  
I will pay the registration fee for the amount of           €  
The participants have to pay the registration fee by inter-bank transfer to:
Ciancio Vincenzo, Restuccia Liliana
account n. IBAN IT 05 I 05036 16504 DRO696192624 held at
Banca Agricola Popolare di Ragusa, Messina, Italy, Agenzia n.4
indicating “registration to THERMOCON'16”
and communicate the payment sending by e-mail a copy of the bank receipt to the address thermocon16@unime.it
 
Comunication
Please, indicate here your eventual questions or special requests:
 I authorize that my personal date are used for information purpose by the organizers of the
    THERMOCON'16 (according an Italian Law about the privacy of personal data).
 
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