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Events and Meetings Office - University of Trento
Molino Vittoria, Via Verdi 6, 38100 Trento - Italy
fax: +39 0461 88 3222

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Family Name: ___________________________________

Institution: ___________________________________


Total amount: _____________________


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Credit Card Number: ___________________________________

Expiration Date: ___________________________________

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Reason for payment is: FEE - CAMAD 2006 Workshop


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Date _____________________

In accordance with Italian Law art. 13 D. Lgs. 196/2003 we hereby declare
that any personal information in our possession will be used
for the purposes of the workshop only.