ACIVS 2015 Registration Form
Advanced Concepts for Intelligent Vision Systems 2015
Please print the form, fill it in and send the scanned version to iplab@dmi.unict.it  
General Information
Last Name:  	
First Name:  	
Title (Prof./Dr./Mr./Ms.): 	
Affiliation:	
Postal Address:	
City Province/State: 	
Postal Code: 	
Telephone, Fax: 	
E-mail Address: 	
Invoice data
Institution name and address, as on invoice (if other than the affiliation above)

		
VAT payer number or NIP (only EU/Polish participants): 
	
Registration fees
Please check a box:
Regular	      550  EUR		
IEEE Member	      500  EUR		
Student (student ID required)	      300  EUR		

Papers
Papers ID numbers: 	
Note that the registration fee covers only one paper. If you are registering more papers please pay 200EUR for each additional paper.
Number of additional papers:	
Additional fees
Extra ticket for social events (welcoming reception, banquet, city tour):	Number of tickets ______x120 EUR	

Total amount of payment
Total amount of payment: 	EUR
Method of payment
Copy of the payment should be sent together with this registration module.
The total fee should be paid  by 
- Credit Card by PAYPAL (with additional fee due to paypal extra) at the following link: insert LINK 
- or by Bank transfer to the following account:
Beneficiary: Associazione IPLab
Beneficiary Address: c/o Dipartimento di Matematica e Informatica, viale A. Doria 6, 95125 Catania (Italy)
Beneficiary Fiscal Code: 93183000871
Bank: Banca Generali s.p.a Sede operativa Trieste
Bank Address: corso Cavour 5/A - 34132 Trieste
ABI: 03075
CAB: 02200
C/C: CC8500483136 
CIN: Z
BIC SWIFT CODE: BGENIT2T
IBAN: IT 05 Z 03075 02200 CC8500483136
REFERENCE/CAUSAL: COMPLETE NAME ACIVS 2015 REGISTRATION

IMPORTANT: exchange rates and bank transfer commissions are at your charge.
Please attach the bank transfer confirmation receipt while sending the registration form.