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					                                                             Registration Form
                                                     The Future of Education Conference
                                                       Florence (Italy), 7 - 8 June 2012
Please complete all the yellow sections of the registration form and send it together with a copy of the bank transfer (not mandate of payment)
via Email (scanned version) to science@pixel-online.net

I, the undersigned request to participate in the second edition of "The Future of Education" Conference
PARTICIPANT INFORMATION
Name and Surname
Fiscal code or social security
number
Address
Postcode
City
Country
Telephone
E-mail
How did you know about the
conference?
Special Dietary Requirements
If you are willing to present a paper during the conference please
indicate the title and the code of your paper:
                                                                                        Speech
Please specify what kind of presentation you would like to deliver.
                                                                                        Poster Presentation
Please only tick ONE.
                                                                                        Virtual Presentation (not attending in person)
ISTITUTION INFORMATION
Name of Institution
Address
Postcode
City
Country
VAT Number (only for EU countries)
Please verify the validity of your VAT number on the following web site:
http://www1.agenziaentrate.it/servizi/vies/vies.htm

REGISTRATION FEE - Please select the appropriate registration option:
                                                                  Participant                  Virtual presentation
                    Registration Fee
                                                             (attending in person)          (non attending in person)

Early Registration (by 19 March 2012)                               € 300.00                        € 200.00                Attending in Person

Standard Registration (by 27 April 2012)                            € 350.00                        € 250.00                Virtual Participation

Late Registration (after 27 April 2012)                             € 400.00                        € 300.00

Participation modality (choose one option from the
drop box menu)
Date of payment (dd/mm/yyyy)                                                                     3/20/2012      4/28/2012
Registration Fee                                                                        Please insert the date of payment and the participation modality
                                                                                                            Me personally

                 Extras                Number of items        Fee            Subtotal
                                                                                                            My Institution or Company
Conference Proceedings                                   €       80.00   €         -
Video Recording                                          €       40.00   €         -
Social dinner on 07/06/2012                              €       30.00   €         -
Social Dinner on 08/06/2012                              €       30.00   €         -

I would like the invoice to be issued to (choose one option from the drop box menu):                                         My Institution or Company
Based in Italy
Total to be paid                                         Please insert the date of payment and the participation modality

BANK TRANSFER
I am aware that it is not possible to pay the registration fee on site and I enclose a photocopy of the bank transfer made to PIXEL for
the amount of € _________ . All bank charges are paid entirely by myself.

Date: …………………….                                                                         Signature: ……………………………………………………
    Please download form the following link the bank account details to pay the registration fee:           Pixel Bank Details

				
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