Renaissance in Florence-Last Supper images


PAYMENT FORM

( Florence, March 11-18, 2012)

Personal information
Institute of Provenance / Company

Gender
Sesso
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Titolo
Name
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*
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Home Address
Indirizzo
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Città
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Country
Paese
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Cap
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ex: +39 055 1234567
Email
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Passport n.
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Accompanying person
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Institute of Provenance/Company
Istituto di provenienza/Azienda
*
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Professione
*
Address
Indirizzo
Town
Città
Country
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Cap
Tel

ex: +39 055 1234567
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ex: +39 055 1234567
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In caso di fatturazione all'istituzione o azienda,
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Fees
    Total Price  
Registration fee for the workshop - multiple room - 7 nights 
350,00
    Total Price  
Registration fee for the workshop - Single room 
410,00
    Total Price  
Registration fee for single participant without accomodation 
250,00
* required / obbligatorio
** (Max one item) / ** (Massimo un elemento)

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