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INSME MEMBER REGISTRATION FORM 6th INSME Annual Meeting 2010 “SME Innovation: boosting development and Growth in times of change” Rio de Janeiro – Brazil 10-13 May, 2010 Sofitel Copacabana Av. Atlântica 4240 - Copacabana Please send this registration form by e-mail or fax by April 30th, 2010 to: INSME - International Network for SMEs INSME Secretariat c/o IPI Viale M. Pilsudski, 124 00197 Rome – Italy Fax: +39 06 80972443 E-mail: email@example.com Website: www.annualmeeting2010.insme.org Please fill in, in capital letters, the fields below with the relevant information: □ Mr. □ Mrs. □ Miss □ Dr. □ Prof. First Name: ______________________________________________________ Last Name: ____________________________________________________________ Organisation Name: ______________________________________________________ Title/Position within your organisation: ____________________________________ _______________________________________________________________________ Address:_______________________________________________________________ _______________________________________________________________________ City Code: _____________ City: __________________________________ Country: _______________________________________________________________ Telephone No.*: _________________________________________________________ Fax*: __________________________________________________________________ E-mail: _________________________________________________________________ Website: http://___________________________________________________________ Date of arrival in Rio: ___ / ___ Date of departure from Rio: ___ / ___ Do you require a visa to enter in Brazil? □ yes □ no Signature ____________________________________________________________ * Please, type telephone and fax numbers as they should be dialled from outside your own country – including country and city prefixes 2 I am an INSME Member and I would like to attend the INSME 2010 Annual Meeting on the following days: Monday, May 10, 2010 Institutional Thematic Round Tables will be available on the morning of May 10th, for free and upon pre-booking, for those INSME Members interested in discussing with Brazilian organizations and other international delegates about selected themes. The Institutional Round tables aim to provide a specific moment and a meeting room for matchmaking, where participants will have the opportunity to discuss and make presentations about their institutions, projects and potential partnerships among other delegates. Two rooms will be equipped with audiovisual facilities for a maximum audience of eight people. In case that you are interested in booking an institutional meeting and/or making a presentation during a round table (duration about one hour), please indicate your expression of interest below. We will analyze your demand and search for possible matches, accordingly to the availability of counterparts. The INSME Secretariat will contact you soon in this regard to follow up. Please acknowledge that INSME can not guarantee that a matching institution or individuals will be found accordingly to your demand. □ yes □ no Topic for the Roundtable:____________________ Duration:____________________ Attach an abstract if you can. Sixth INSME Association General Assembly (afternoon) □ yes □ no Opening ceremony and Welcome Cocktail □ I will attend □ The person accompanying me will attend His/her full name is:____________________ Please tick the box if you would like to request a vegetarian meal □ Myself □ The person accompanying me Tuesday, May 11, 2010 International Conference on “SME Innovation: boosting development and Growth in times of change” (morning and afternoon) □ yes □ no Welcome dinner □ I will attend □ The person accompanying me will attend His/her full name is:____________________ Please tick the box if you would like to request a vegetarian meal □ Myself □ The person accompanying me Wednesday, May 12, 2010 International Conference on “SME Innovation: boosting development and Growth in times of change” (morning) □ yes □ no 3 Industrial site visit to Rio Tech Park (afternoon) □ I will attend □ The person accompanying me will attend Cultural and social visit to the Rio City Hall (late afternoon - early evening) □ I will attend □ The person accompanying me will attend Thursday, May 13, 2010 Rio City Tour (morning)* □ I will attend □ The person accompanying me will attend * Note: Participation in the Rio City Tour is optional and on a fee basis to all participants. INSME Delegates willing to participate at Rio City Tour shall contact directly the Tour Desk that will be available at the Conference’s venue in order to schedule Rio site visits. Notes: 1 . See list of recommended hotels - ANNEX I – for your reservation 2. Check about Visa requirements in time with the Brazilian Embassy in your country NOTICE TO THE EFFECT OF LEGISLATIVE DECREE NO. 196/2003 Following to the requirements stated by art. 13 of the Legislative Decree no. 196 of June 30, 2003, on “Personal Data Protection Code” (following: the “Code”), we would inform you that your personal data are/will be processed by the INSME Association, with respect to the applicable law, exclusively for the aims related to its purposes and to consider your application for participation in the INSME Association meeting, by manual instruments as well as informatic and telematic, and oriented to the purposes above as to respect the safety and the confidentiality of the processed data. In relation to your personal data, we inform you, that art. 7 of the Code, recognises to you, in the quality of data subject, specific rights, among which the right to obtain the updating, rectification or, where interested therein, integration of the data. The Controller in charge of your data processing, will be the INSME Association, having its registered office in Rome, c/o IPI, Viale M. Pilsudski, 124, 00197 Rome – Italy. 4 ANNEX I Transportation from the airport to the hotels and vice versa will be provided by the organizers upon previous communication regarding the flight schedules. The INSME Secretariat cannot take care of your hotel booking. Please contact the hotels directly and in time. Normally a credit card number is requested to make the reservation. 5 6 7
"INSME Association Member registration form_15feb"