5TH INTERNATIONAL WORKSHOP
NEURONAL CODING 2003

FORM A - REGISTRATION FORM

Please complete and return this form, together with your payment, to: 

Secretariat - Dr. Lucia Simonini 
5th International Workshop on Neural Coding 
Museo di Storia naturale della Lunigiana 
Fortezza della Brunella 
I-54011 Aulla (MS) 
Italy 
PHONE: +39-0187-400252 
FAX: +39-0187-420727 
EMAIL: neural-coding-2003@neuroheuristic.org 

Please complete this section accurately; the information you provide will allow us to correspond with you efficiently, and it will also be used for your delegate badge at the Congress. 

Participant (Please TYPE or PRINT IN BLOCK LETTERS) 

Title          Prof.      Dr.      Mr.      Mrs.      Ms. 		
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Surname	Initials	
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First name		

If you are a presenting author, please give the title of your presentation	
Presentation type:           Poster             Oral	

Address for List of Participants' Purposes:

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Institution	
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Department 	
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No.                           Street                                                                    Suite/Apt. 	
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City                              Postal Code (ZIP)                  State/Province                Country 	
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Telephone (office hours) country code/city code/number         Fax country code/city code/number 	
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E-Mail address 	

Mailing Address if Different From Above:

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No.                           Street                                                                    Suite/Apt. 	
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City                              Postal Code (ZIP)                  State/Province                Country 	

Accompanying persons 
List only those individuals registering for the Accompanying Persons' Program: 

Surname	First name	Title	
						
Surname	First name	Title	

Registration fees 
Please check the appropriate box/s 

The regular fee as well as the student registration fee includes Workshop Proceedings, access to all scientific sessions and social events (welcome party, coffee breaks, 4 lunches, 4 dinners and 2 Workshop excursions). The accompanying person fee covers all social events, except meals (arrangements can be provided) and except the access to the scientific sessions. 

 	Until
Date: June 30, 2003	After
Date: July 1, 2003	
Regular Participant	 Euro 300.00 	 Euro 380.00 	
Students and Juniors*	 Euro 200.00 	 Euro 280.00 	
Accompanying Person/s  x_____	 Euro 120.00 	 Euro 200.00 	

* Refers to PhD students and non-tenured junior scientist (less than 32 years old). 
Registration form must be accompanied by a copy of their student ID or a letter from their head of department confirming their status. 

Payment 
Please indicate amount enclosed and ensure that you send your fully completed registration form together with your payment:

Total Fees   Euro _______________

Method of Payment : BANK TRANSFER 
We are sorry but no Credit Card payments can be accepted. 

Bank Transfer with your name and address indicated on the reverse. 
If payment is made for more than one person or by a company please make sure all names are indicated and send fully completed registration forms together with a copy of the bank transfer. 

Please make drafts payable to :    “5th International Workshop on Neural Coding" 
      Name of the bank:   Cassa di Risparmio di Firenze
      Branch:     Filiale di Aulla              Address:   Piazza Mazzini 9,  I-54011 Aulla (Italy)
      Bank code:     ABI = 6160        CAB = 69860       Account number:   cc/10208/00
      IBAN code:     IT70P0616069860 0000 10208c00

NB: Bank charges are the responsibility of the payee and should be paid at source in addition to the registration fees.

Cancellation policy:
Refund of Registration Fees will be made as follows:
Post-marked prior to May 31, 2003 - full refund less Euro 40 handling fee
Post-marked from June 1, 2003 - 50 % refund
Post-marked after July 1, 2003 - no refund 

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Place and Date	Signature