ACIVS 2016 Registration Form
Advanced Concepts for Intelligent Vision Systems 2016
Please print the form, fill it in and send the scanned version to acivs2016@gmail.com

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 (please note that at least one author of an accepted paper must register at the REGULAR rate even if the author is a student):
	Regular – No IEEE Member	550  EUR	
	Regular - IEEE Member	500  EUR	
	Student (student ID required)	350  EUR	

Papers
Papers ID number(s): 	
Note that the registration fee covers only one paper. If you are registering more papers please pay 200EUR for each additional paper.
Number (and ID) 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) -> see the link on the website
- or by Bank transfer to the following account:
Beneficiary: Associazione Think 4 Vision
Beneficiary Address: via Gallipoli, 95
73024 – Maglie (LE) 
Beneficiary Fiscal Code: 92029170757
Beneficiary Partita IVA: 04812970756
Bank: BANCA PROSSIMA S.P.A
Bank Address: PIAZZA PAOLO FERRARI 10
MILANO Italy
BIC SWIFT CODE: BCITITMX
IBAN: IT04A0335901600100000143363  
REFERENCE/CAUSAL: “<Please insert your complete name> ACIVS 2016 REGISTRATION”
IMPORTANT: exchange rates and bank transfer commissions are at your charge.
Please attach the bank transfer confirmation receipt while sending the registration form.