Registration form
ICIMP 2009

May 24-28, 2009 – Venice/Mestre, Italy   
(Note: One registration allows one participant to assist to all conferences)

Please fill in the form, sign it, and send it via one of the following:
Fax: 1-302-475-6432
e-mail: manuela@vicov.com
mail: VICOV Event Expert LLC, P. O. Box 8027, Wilmington, DE 19803, USA

Title (Student/Prof/Dr): ______ First Name: _____________ Last Name: ___________________

Paper number (e.g., #30254) (for authors only: only one paper per form) ________________

Institution: _________________________________________________________________

Street Address: ______________________________________________________________

City: __________________ State: ____________ Zip: ___________ Country: _____________

Phone: __________________ Fax: ___________________ Email: ______________________

This information may be sent later to manuela@vicov.com

Arrival Date:        _______________ at ______________ with Flight N°: ________________

Departure Date:     ______________ at _______________with Flight N°: _________________
A. Conference Registration Fees
The full registration fees include: the welcome cocktail, attendance to all the WebTel 2009 conferences (AICT 2009, ICIMP 2009, and ICIW 2009), the coffee breaks, the gala dinner, and the CD-proceedings for the conference where the paper is registered.
 	IEEE Member	Non-IEEE Member	 	
Academic Rate
IEEE Membership # ………………	565 €	615 €	______ €	
Industry rate
IEEE Membership #........................	765 €	815 €	______ €	
Late payment *
100 € | after February 15, 2009
150 € | after March 15, 2009
* late payment acceptable for attendance only, not for paper registration	                                                                               
   ______ €	
Additional Proceedings: 103 €/CD
	                                                                                 
 ______ €	
Extra pages: 110 € / page	
______ €	
Additional Gala Dinner: 95 €							     
 ______ €	
    TOTAL A: __________ €
B. Tutorials 
Note: see final program
 
Tutorials are free of charge
C. Hotel special price (SOLD OUT) 
Note: As of February 15, pre-booked rooms have been filled. Information on nearby hotels is posted under “Hotels and Travel” section of the conference page. You would have to make your own reservation directly with the hotel.

http://www.iaria.org/conferences2009/HotelsTravelICIMP09.html

TOTAL C: _________0_ €

D. Social event 
(see Preliminary program)

Visit of Venezia Islands (full day with Lunch)    140 € x __  person(s) = _______ 
(Venezia Saint Mark's Basilica, Doge's Palace, Rialto's bridge, Dorsoduro with Frari's church, Visit of Murano and Buranon Islands by boat with visit of Murano glass factory)

Total (A+C+D):       _________ €
If wire transfer:                         40 €

TOTAL:    _____________________€

Payment of Fees (check one of the methods): 

__ By Credit Card   (preferred method)            (____ Mastercard or ____Visa)          
 
Card number:    _________________________________________________________
Expiration date:  _________                                                                   
Holder's Name: ________________________ Holder’s (hand) Signature: _________________
                                                                   
__ By Wire Transfer (please add 40 € for processing the wire transfer)
     Contact manuela@vicov.com for the wire transfer accounts information 
      
Date and Author’s Name: _____________________________
Author’s (hand) Signature: __________________________________

Important: Please note that NO refund on any service mentioned above will be issued after February 15, 2009 as all the services are ordered and paid when the registration form is received and payment honoured. 

In case of an emergency that prevents the original presenter from attending, the registration may be transferred to another presenter.