Surname *
Your answer
Name *
Your answer
e-mail *
Your answer
Your answer
Position *
Complete address for receipt (Street, City, Postal code, Country) *
Your answer
What are you going to attend? *
Are you going to submit an abstract for poster presentation?
IBS membership *
COSTNET membership *
Do you need a reimbursement from the COSTNET Action? [allowed only if you are a member of CA15109 or you are a student, up to 30 persons will be reimbursed and the request can be done until 15 March]
If you are a member of COSTNET Action CA15109 and you do not ask for the reimbursement, do you want to pay the fee as IBS or not IBS member?
If you are a member of COSTNET Action CA15109 (or you are a Student who ask for the reimbursement) and you do not buy the accommodation and subsistence package (see below), how many lunch ticket do you want to buy?
Accommodation *
If you request the accommodation & subsistence package, select for which days [if you are in the case for which the registration fee is not free, the costs of the lunch tickets and the social dinner will be deduced from the package cost]
Please indicate any dietary requirements (vegetarian, gluten free, etc.) *
In case you ask for the COSTNET reimbursement, will you confirm your partecipation even in the case the request of reimbursement will not be accepted? *
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