Registration


                    
                    
                    
                    
                      
                        
                          
                            
                              
                                Name:*
                                
                                  
                                    
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                                Title
                                
                              
                            
                            
                              
                                Address:
                                
                                  
                                    Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry
                                  
                                
                              
                            
                            
                              
                                E-mail:*
                                
                              
                            
                            
                              
                                Phone Number:*
                                
                              
                            
                            
                              
                                Fax
                                
                              
                            
                            
                              
                                VAT / TAX ID number 
                                
                              
                            
                            
                              
                                FISCAL CODE (for Italian only)
                                
                              
                            
                            
                              
                                Are you member of an EMDR Europe Association? 
 If yes please write the name of your National EMDR Association 
                                
                              
                            
                            
                              
                                Are you member of other EMDR national associations in the world? 
 If yes please write the name of your EMDR National Association 
                                
                              
                            
                            
                              
                                BILLING INFORMATION 
                                (Please note that the invoice will be automatically headed and sent to the person and address indicated in the above DELEGATE INFORMATION section. If the invoicing information is different please complete the information section here below)
                              
                            
                            
                              
                                NAME: (person or institution) 
                                
                              
                            
                            
                              
                                Address
                                
                              
                            
                            
                              
                                Postal code
                                
                              
                            
                            
                              
                                City
                                
                              
                            
                            
                              
                                Country
                                
                              
                            
                            
                              
                                Email
                                
                              
                            
                            
                              
                                Tel
                                
                              
                            
                            
                              
                                Fax:
                                
                              
                            
                            
                              
                                Vat/Tax ID number
                                
                              
                            
                            
                              CONFERENCE CANCELLATION POLICY 

                                Notification of cancellation must be made in writing and sent via email to: [email protected]

                                For cancellations of participation in the conference between February 1st and June 1st 2015, 75% of the registration fee will be refunded. No refund can be made for cancellations received after June 1st , 2015. The Organizing Secretariat will refund your registration fee after the conference, less € 50,00 that will be held to cover administrative charges. Refunds will be net of bank transfer costs.
                              
                            
                            
                              
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