COLLEGIUM RAMAZZINI

All participants are asked to register online using the form below. Once your registration has been received and processed, you will be sent a confirmation e-mail. If you have not received this confirmation within two weeks after the date of your registration, please send an email to events@ramazzini.it.

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Mailing Address: *
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Cellphone:
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please check all that apply:

	I am a Fellow of the Collegium Ramazzini
	I am not a Fellow of the Collegium Ramazzini (external participant fee of €250) Fee includes meals, conference materials and ground transportation. Lodging excluded.
	I will be accompanied by a spouse or guest (forfeit fee of €250) Fee includes meals, conference materials, ground transportation and lodging. Name of guest:
	I prefer vegetarian meals
	I have other special needs (please specify below)

CONFERENCE SESSIONS AND EVENTS

I plan to attend:

All sessions and events

alternatively, please check all that apply:

Friday 22 October 2010

Welcome Dinner

Saturday 23 October 2010

	Council of Fellows Statutory Session (Fellows only)
	Saturday Lunch
	Scientific Sessions I-II
	Presentation of the Ramazzini Award and Ramazzini Lecture
	Social Dinner

Sunday 24 October 2010

	Scientific Session III-IV
	Farewell Lunch

TRAVEL INFORMATION

Friday, 22 October 2010

Bologna International Airport
Airline:
Flight #:
Arrival Time (0:00-24:00):

Modena Centrale Train Station
Arrival Time (0:00-24:00):

Carpi Train Station (I will walk 1 block to the Hotel Touring)

I will arrange my own ground transportation to Carpi

I have other travel plans as indicated:

Departure

Sunday, 24 October 2010
	Bologna International Airport Airline: Flight #: Departure Time (0:00-24:00):
	Modena Centrale Train Station Departure Time (0:00-24:00):
	Carpi Train Station (I will walk 1 block from the Hotel Touring)
	I will arrange my own ground transportation from Carpi
	I have other travel plans as indicated:
Monday, 25 October 2010
	Bologna International Airport Airline: Flight #: Departure Time (0:00-24:00):
	Modena Centrale Train Station Departure Time (0:00-24:00):
	Carpi Train Station (I will walk 1 block from the Hotel Touring)
	I will arrange my own ground transportation from Carpi
	I have other travel plans as indicated:

FEES AND JUBILEE DONATIONS

I am a Fellow of the Collegium Ramazzini and would like to pay my 2010 annual membership dues
	€130 ($200 USD)



I would like to participate in the Collegium’s Jubilee Fund to help colleagues in need attend annual meetings.
	€25 - Carpigiano Bernadino Ramazzini was born in Carpi in 1633.
	€75 - Parmense Bernardino Ramazzini graduated in Medicine in Parma in 1659.
	€125 - Modenese Bernardino Ramazzini chaired the Faculty of Medicine in Modena for eighteen years, from 1682-1700.
	€250 - Padovano Bernardino Ramazzini chaired the Faculty of Medicine in Padova for fourteen years until his death in 1714.

Cancellations must be communicated by e-mail to events@ramazzini.it prior to September 17, 2010 for a 50% refund of conference fees.