Application Form

Fields depicted by an asterisk (*) are required for everyone
Fields depicted by a hash (#) are required only for italian applicants

Personal data *First Name *Surname I am a Doctoral/PhD Student

For PhD students only *In which university? *Name of the doctorate *Name of the doctorate's responsible

*Organisation Department *Street address *Zip Code *City *Country *E-Mail address *Phone Fax

*Invoice Data *Name or Organisation Name #Fiscal Code or VAT Number (Codice Fiscale o Partrita Iva) *Street address *Zip Code *City *Country

The above mentioned data subject may exercise all the rights set forth in L.N. 196/2003 - Art. 13 (Privacy Law)

*Payment Options

	Bank Transfer to be paid within December, 18th 2008 (early registration) or within January, 23rd 2009 (late registration)
	Credit Card to be paid out the opening day at the congress secretary desk
	Cash to be paid out the opening day at the congress secretary desk

Dietary Requirements Should you have any special dietary requirements or other specific needs you are kindly requested to specify them:

Congress Dinner

yes (€30 per person)

number of person

Separate receipt for the dinner

use invoice data from above

Invoice Data for the Congress Dinner *Name or Organisation #Fiscal Code or VAT Number (Codice Fiscale o Partrita Iva) *Street address *Zip Code *City *Country

CIdE - Centro Interuniversitario di Econometria - Aggiornato al 01/04/2008

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