11th ESP 2005 - Aix-les-Bains, France, September 3/8, 2005

Registration

Please fill in and submit this form. To facilitate communication you are kindly requested to fill as many fields as possible (particularly, e-mail address). Please take into account that the registration process will not proceed if at least the fields with an asterisk are not filled. To move from field to field use the Tab Key or the mouse, NOT the Return key.

*Last (Family) name:

*First (Given) name:

Middle name:

Department:

Institution:

*Address:

*City:

*Country:

*Postal Code:

Phone:

Fax:

E-mail:

Congress registration fees (in Euro = €)

Please check appropriate boxes

	Payments received
	Before June 30 2005	Before August 15 2005	On-site Payment
ESP-Members	Euro 350	Euro 400	Euro 500
ESP-Members (Emerging Countries)	Euro 250	Euro 300	Euro 400
ESP-Members (Students)*	Euro 180	Euro 220	Euro 260
Non-ESP-Members**	Euro 500	Euro 550	Euro 650
Invited speaker/chairperson
Accompanying persons	Euro 45 per person/s
Social Dinner Tuesday, Sept. 6, 2005	Euro 45 per person/s

* Students: Certification letter required.

** For non-ESP members: You may apply for ESP membership at the ESP website.

Registration dues may be paid by the following methods. Please check the one you intend to use:

Credit card

Please download the debit statement form and send it to the ESP Treasurer by normal mail or fax (+39 050 3152760). Accepted credit cards: Access, Carta Si, Carte Bleue, Diners Club, Eurocard, MasterCard or Visa. Provide the following information: complete card number, expiration date, the amount to be debitted written in numerals and in words, your name as it appears on the card, address, postal code, and country. Sign the request.

Bank order

to Banca Toscana, Pisa Ag. 1 Branch, Via Borgo Stretto 40, 56100 Pisa, Italy (Swift: TOSCIT 3 F 701; European Bank Code: IT 10 Q 03400 14001 000000211795), European Society for Photobiology account number 2117/95. Please ensure that the bank includes your name and address so that the source of the payment can be easily identified. (Note: the charges you have to pay to your bank are not included in the membership fee.)

Cheque

made out to European Society for Photobiology. (Please add 2 EUR to partially cover bank charges). Send your cheque direct to the ESP Treasurer.

The ESP Treasurer is Dr Francesco Ghetti, CNR Istituto di Biofisica, Area della Ricerca di Pisa, Via G. Moruzzi 1, 56100 PISA, ITALY (Telephone: +39 050 3152764, Fax: +39 050 3152760, E-mail: francesco.ghetti@pi.ibf.cnr.it). Please contact him if you have any questions.

To register, please press Submit Form:

To clear the form and start over, please press Clear: