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MaX KICK-OFF Meeting Registration Form
This is the registration form for participants attending the MaX KICK-OFF Meeting in Modena (IT) on December 13-14, 2018.
The meeting will take place in Fondazione Collegio San Carlo, via San Carlo 5, 41121 MODENA.
For any information please contact Maria Bartolacelli maria.bartolacelli@max-centre.eu or Luisa Neri luisa.neri@max-centre.eu
Name *
Your answer
Surname *
Your answer
Affiliation *
Your answer
Address
Please, indicate your street address, City, zip code
Your answer
Country
Your answer
e-mail address *
Your answer
phone number *
Your mobile phone number will be used only in case of need during the meeting.
Your answer
Will ou attend teh SOCIAL DINNER December 13? *
Required
dietary requests
Your answer
arrival date
MM
/
DD
departure date
MM
/
DD
/
YYYY
Are you interested in a "GET TOGETHER" on Wednesday December 12 - from 18.00
Submit
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