11th Annual Meeting of the
International Society for the History of the Neurosciences (ISHN)

Collegio Cairoli
Pavia, Italy

Wednesday, 21 June - Sunday, 25 June 2006

Registration

Participants should send a Registration Form by regular mail, by fax, or preferably ON LINE.
Please fill in carefully and send the registration form below. Each participant must submit his/her own registration form.

Fees

• Registration fee: € 300
• Accompanying person: € 160
• Student fee: € 160

The registration fee includes:

Welcome Cocktail, Coffee breaks, Gala Dinner, Working lunches, Certificate of attendance, Conference kit.

Accompanying person fee includes all social events and lunches.

Personal identifying data

Family Name (*) First Name (*)
Institution   Address
City         Province/State
ZIP code     Country
E-mail (*) Mobile Phone
Phone number FAX     
Accompanying person Registration (*)           Full registration Student

(*) mandatory field

Accommodation

Accommodation can be booked by filling in the accommodation form.

• Hotel **** Single € 125,00 Double € 140,00 per night;
• Hotel *** Single € 90,00 Double € 110,00 per night;
• College accommodation € 50,00 Double € 70,00 per night;

Accommodation Data

Accommodation choice Hotel 4 stars Hotel 3 stars College no accomodation Number of nights
N° Single room(s) N° Double room(s)
Arrival date dd/mm/yyyy Departure date dd/mm/yyyy

Accommodation payment: You are requested to send the full payment for college accommodation. For Hotel accommodation a credit card is requested. In case of no-show the hotel will charge a fare of one night.

Payment

Payment should be made in euros (€) by:

• Credit Card (Visa, CartaSi, EuroCard/MasterCard).
• Bank transfer to "Comitato ISHN" - Banca San Paolo Imi, Corso Cavour - PV, ABI 1025, CAB 11303, C/C 3270 CIN D, IBAN IT81D010251130310000003270 BIC:IBSPITTM
  Please note that all banking fees have to be settled by the remitter.

A summary of sum due will automatically appear in the next page after submitting data.

PLEASE SEND BY FAX (+39 0382 304892 -Pragma Congressi Srl, Corso Mazzini 9, 27100 Pavia) THE AUTHORIZATION FOR CREDIT CARD PAYMENT OR THE COPY OF THE BANK TRANSFER AFTER RECEIVING ON-LINE CONFIRMATION OF YOUR REGISTRATION.

You may print the following form and fax it to Pragma Congressi Link to the form

Charge will appear on your Credit Card statement as "Manifestazioni Golgiane - Congresso ISHN"

By sending this form I accept the conditions stated in the Programme. According to the Art. D Lgs 196/03 the Conference Organizers are authorized to use personal data for purposes connected to the Conference management.