Family Name (required)

Name (required)

Mrs./Mr. (required)

 Mrs. Mr.

Academic Title (required)

Email (required)

University/Institution (required)

Department/Institute

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Payment Type (required)

 Credit Card PayPal Bank Transfer Fellowship Grant offered by Stelar

If you performed a bank transfer, please provide its number

Data for Receipt (Including receipt header, institution, address and fiscal code)

Are you attending the social dinner? (required)

 Yes No

Do you need a particular diet? (required)

 Yes No

If you answered yes to the previous question, which kind of particular diet do you need

I hereby authorise the congress organisers to handle and process my personal data under the Italian Legislative Decree n.196 of 30/06/2003.
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