Registration Form

Name *

Surname *

Born in *

Country/District *

Birth Date *

Postal Code *

Resident in *

Country/District *

Address in *

Postal Code *

Phone Number *

Email address *

Name of the Institute where you are employed *

REGISTRATION *

Requests to be registered for the 13th edition of the Conference on Fast Field
Cycling NMR Relaxometry, which will take place in Palermo in the classrooms of
the University of Palermo, from 10 to 13 September 2024

Mark with only one oval.

YesNo

REGISTRATION FEE *

The registration fee for participants is 450 Euros for senior and 300 Euros for
students under 35. To cover the management costs of the Conference, the SPAIS Association will withhold a fee equal to €20 from the registration fee. The registration fee covers: conference material, lunches (from 10th to 13th September, included), coffee breaks, social dinner.

Mark with only one oval.

Faculty/Industry/Other € 450Trainee (postdoc/student UNDER 35) € 300400€ (fee for NON-attendees at social dinner)

CANCELLATION POLICY *

• In case of cancellation up to 1 month: reimbursement of the fee up to 50% (to guarantee a minimum coverage of expenses)

• In case of cancellation more than one month before the conference, there will be no refund.

I declare that I have read and accept the cancellation policy *

Yes

DATA PROCESSING *

By sending this form, you authorize the processing of the data provided pursuant to the GDPR (EU) n. 2016/679.

I authorize *

Yes

SOCIAL DINNER *

YesNo

Will you have any guests traveling with you that would like to attend the social event, for a fee? *
Mark with only one oval.
YesNo

Notes/Dietary Requirements *

REGISTRATION PAYMENT *

• Type of payment *
  Bank transfer.Credit or Debug Card (VISA/Mastercard)
  

• Payment data *
  

  I declare that I have made the payment via bank transfer (cod. IBAN
  IT17L0306909606100000187746) made out to the SPAIS Association with the
  reason: “FFC NMR Relaxometry 2024_NAME SURNAME”

  Bank transfer.

• Below are the bank transfer details * (amount, date, number)