Registration form
ICIMP 2010
Registration includes unrestricted access to attend all Webtel 2010 presentations for the registrant

May 9-15, 2010 – Barcelona, Spain
Please fill in the form, sign it by hand, and send it via one of the following:
Fax: 1-302-475-6432
E-mail: manuela@vicov.com 

Title (Student/Prof/Dr): ____First Name: _______________ Last Name: ______________

Paper number (e.g., #10254) (for authors only: only one paper per form) ______________

Institution: _______________________________________________________________

Street Address: ___________________________________________________________

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

Phone: __________________ Fax: ___________________ Email: __________________

A. Conference Registration Fees
The full registration fees include: access to all the conferences, the welcome cocktail, the coffee breaks, the gala dinner, the CD-proceedings for the conference where the paper is registered (including CSDL and IEEE Xplore Publication, and indexing), and the participation to all the scientific events under the WebTel 2010 umbrella. 
 	IEEE Member
IARIA Fellows	Non-IEEE Member	 	
Academic Rate
IEEE Membership # ………………	565 €	615 €	______ €	
Industry rate
IEEE Membership #........................	765 €	815 €	______ €	
Late payment *
- after February 21/2010, 100 €
- after March 6/2010, 150 €
* late payment acceptable for attendance only, not for paper registration	                                                                               
   ______ €	
Additional Proceedings: 100 €/CD	                                                                                 
   ______ €	
Extra pages: 105 € / page
(over 6 pages) 	
______ €	
Additional Gala Dinner: 95 €							     
 ______ €	
    TOTAL A: __________ €
B. Tutorials 
Note: see final program
 
Tutorials are free of charge for all the attendees

C. Hotel special price (LIMITED TO THE FIRST 60 REGISTERED) 
Arrival date   ____________	Arrival time _____________

Departure date _____________ 	Departure time _____________

Number of nights: ________
Note: a hotel day starts at noon
 
Novotel Barcelona Sant Joan Despi (All taxes are included in conference prices)

- Room single + breakfast						90 € x ___nights  = _______
- Room double + 2 breakfasts					105 € x ___nights  = _______
- Room single + breakfast + dinner					120 € x ___nights  = _______
- Room double + 2 breakfasts + 2 dinners				165 € x ___nights  = _______

Total C: __________ €

D. Social event
(See Preliminary Program)

Trip/Social Event (full day, with lunch)     			100 € x __ person(s) = _______ €
(See trip schedule on the Preliminary program)
If ‘credit card”:                                      TOTAL (A + C + D):       _________ €
If “wire transfer”:			     TOTAL (A + C + D + 40 €):  ____________€

Payment of Fees (check one of the methods): 

__ By Credit Card   (preferred method)            (____ Mastercard or ____Visa)          
 
Card number:    _________________________________________________________
CVV:  _________________ (this is the 3 or 4 digit number on the back of the card)
Expiration date:  ___________                                                                   
Holder's Name: ________________________ Holder’s Signature: _________________

Credit Card billing address:
Street address:________________________________________________________
City: _______________________________ State: ___________________________
Zipcode/Postcode _____________________ Country: ________________________
                                                                   
__ 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 Signature: ____________________/____________________________
Important: Please note that NO refund on any service mentioned above will be issued after February 21, 2010 as all the services are ordered and paid when the registration is received. 
In case of an emergency that prevents the original presenter from attending, the registration may be transferred to another presenter.