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<body> <div id="PageDiv" style="position:relative; min-height:100%"> <div id="registrationcopia" style="position:absolute; left:176px; top:392px; width:100px; height:100px; z-index:1"> <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"> <html><head> <meta http-equiv="content-type" content="text/html; charset=ISO-8859-1"> <title>Registration nano2011=/</title> <style type="text/css">  </style> </head><body style="color: rgb(159, 64, 0); background-color: rgb(255, 255, 255);" alink="#ff0000" link="#3333ff" vlink="#3333ff"> <form style="color: rgb(0, 0, 102);" action="FMPro" method="post"><input name="-DB" value="nn2012.fp5" type="hidden"> <input name="-Lay" value="registration" type="hidden"><input name="-format" value="reply_to_registration.htm" type="hidden"> <input name="-error" value="new_error.htm" type="hidden"><input name="new" value="new" type="hidden"> <input name="-script" value="abstract" type="hidden"><input name="-script" value="mail_registrazione" type="hidden"> <center> <h3 align="center" style="font-style: italic;"> <span class="Stile28"><big><big><big><big><big><big>n&nn2012</big></big></big></big></big></big></span><br> </h3> <h3 align="center" style="font-style: italic;"><span class="Stile27"><big><big><small>Nanoscience and Nanotechnology</small></big></big>,  1 – 4 October  2012,  INFN - LNF</span><br> </h3> <div align="center"><br> <big><big style="font-style: italic;"><big><span class="Stile27" style="font-weight: bold;">Registration</span></big></big></big> </div> <center> <p></p> <p></p> </center> <hr align="left" width="750"> <table style="width: 500px;" border="0" cellpadding="0" cellspacing="1"> <tbody> <tr style="color: rgb(0, 0, 102);"> <td colspan="4" height="60"> <br> <span class="Stile23"><span class="Stile24"><span class="Stile25"><b><i><font face="Palatino">General information</font></i></b><i><font face="Palatino">:</font><font face="Palatino"></font></i></span></span></span></td> </tr> <tr> <td style="color: rgb(0, 0, 102);" width="141"> <font face="Palatino"><font size="-1">Surname</font></font><font face="Palatino"><font size="-1">*</font>:</font> </td> <td style="color: rgb(0, 0, 102);" width="244"><input name="Family Name" size="30" type="text"></td> <td style="color: rgb(0, 0, 102);" width="94"> <font face="Palatino"><font size="-1">    </font></font><font face="Palatino"><font size="-1"> </font></font><font face="Palatino"><font size="-1">Name</font></font><font face="Palatino"><font size="-1">*</font>:</font> </td> <td width="242"><input name="Name" size="30" type="text"></td> </tr> <tr> <td style="color: rgb(0, 0, 102);"> <font face="Palatino"><font size="-1">Home Institute*</font>:</font> </td> <td style="color: rgb(0, 0, 102);"><input name="Institute" size="30" type="text"></td> <td style="color: rgb(0, 0, 102);"> <font face="Palatino"><font size="-1">   Address</font></font><font face="Palatino"><font size="-1">*</font>:</font> </td> <td><input name="address" size="30" type="text"></td> </tr> <tr> <td style="color: rgb(0, 0, 102);"> <font face="Palatino"><font size="-1">Zip & City*</font>:</font> </td> <td style="color: rgb(0, 0, 102);"><input name="city" size="30" type="text"></td> <td style="color: rgb(0, 0, 102);"> <font face="Palatino"><font size="-1">    </font></font><font face="Palatino"><font size="-1">Country*</font>:</font> </td> <td><input name="country" size="30" type="text"></td> </tr> <tr> <td style="color: rgb(0, 0, 102);"> <font face="Palatino"><font size="-1">E-Mail*</font>:</font> </td> <td style="color: rgb(0, 0, 102);"><input name="email" size="30" type="text"></td> <td style="color: rgb(0, 0, 102);"> <font face="Palatino"><font size="-1">    </font></font><font face="Palatino"><font size="-1">Phone:</font></font></td> <td><input name="phone" size="30" type="text"></td> </tr> <tr> <td style="color: rgb(0, 0, 102);"> <font face="Palatino"><font size="-1">Fax:</font></font> </td> <td style="color: rgb(0, 0, 102);"><input name="fax" size="30" type="text"></td>  </tr> <tr style="color: rgb(0, 0, 102);"> <td colspan="4" height="60"> <br> <span class="Stile23"><span class="Stile25"><b><i><font face="Palatino">Conference arrival and departure</font></i></b><i><font face="Palatino">:</font><font face="Palatino"></font></i></span></span></td> </tr> <tr height="25"> <td style="color: rgb(0, 0, 102);"> <font face="Palatino"><font size="-1">Arrival Date*:</font><br> <font size="-2">(mm/dd/yyyy)</font></font> </td> <td style="color: rgb(0, 0, 102);"><input name="arrival date" type="text"></td> <td style="color: rgb(0, 0, 102);"> <font face="Palatino"><font size="-1">Departure Date*:</font><br> <span class="Stile24">mm/dd/yyyy)</span></font> </td> <td><input name="departure date" type="text"></td> </tr>  <tr height="28"> <td style="color: rgb(0, 0, 102);"> <font face="Palatino"><span class="Stile30"><big>Social Dinner (yes/no)</big>:</span></font></td> <td style="color: rgb(0, 0, 102);" colspan="3"><input name="nights" size="4"></td> </tr>  </tr>  <tr style="color: rgb(0, 0, 102);"> <td colspan="4" style="height: 40px;" height="57"><p align="left" class="Stile29">  </p> <p align="left"><font face="Palatino"><strong><span class="Stile25"><b><i></i></b></span></strong></font><font face="Palatino" size="-1"><strong><span class="Stile25"><b><i>Scientific<font face="Palatino"> information</font></i></b><i><font face="Palatino">:</font></i></span></strong></font></p> <p align="left"><font face="Palatino" size="-1"><strong>PhD Studen</strong>t (yes/no) <input name="num_children" size="4" type="text"> </font><b><i><font face="Palatino">                    </font></i></b></p> <p align="left"><b><i><font face="Palatino">Presenting talk (title)</font></i></b> <font size="+1"><b> <input name="type_of_contr_web" value="talk" type="checkbox"> <small style="color: rgb(0, 0, 102);"><small>oral</small></small>   <input name="type_of_contr_web" value="poster" type="checkbox">  <small style="color: rgb(0, 0, 102);"><small>poster</small></small></b></font><font face="Palatino"><font size="-1">  </font></font></p></td> </tr> <tr style="color: rgb(0, 0, 102);">  <td colspan="4"><textarea name="note" rows="2" cols="88"></textarea></td> </tr> <tr style="color: rgb(0, 0, 102);" height="40"> <td colspan="4"> <hr></td> </tr> <tr> <td height="39"> </td> </tr> <tr style="color: rgb(0, 0, 102);"> <td colspan="4" style="height: 40px;" height="57"><p align="left"><span class="Stile19">Access to INFN-LNF Network resources<br> </span><span class="Stile17">In order to use the internal LNF network and connect to the general Internet, al participants must be authenticated by appropriate credentials. </span><span class="Stile1">In particular, non-INFN users must receive a username and a password. In order to get such credentials from the LNF computing services, non-INFN participants must provide a copy of a valid ID (such as, passport or identity card) in electronic format (scanned image). This should be done fairly in advance to accelerate registration time.</span></p> <table border="1" width="200"> <tbody><tr> <td><div align="center"><a href="https://gosrv.lnf.infn.it:8443/GOWebApp/InsertOspite.jsp?CONF=nn2012&FORMATO_DATA=dd/MM/yyyy&CONF_INIZIO=01/10/2012&CONF_FINE=04/10/2012&ID_UTENTE=502&LANGUAGE=en" target="_blank">Access Network request</a><a href=</a></div></td> </tr> </tbody></table></td> </tr> <tr> <td height="39"><font face="Palatino"><font size="-1">*</font></font><font face="Palatino"><font size="-1">necessary information</font></font></td> </tr> </tbody> </table> </center> <br> <center><input name="-New" value=" Register now " type="submit">     <input value=" Delete form" type="reset"> </center> </form> <br style="color: rgb(0, 0, 102);"> <br style="color: rgb(0, 0, 102);"> <hr style="color: rgb(0, 0, 102);"> <p style="color: rgb(0, 0, 102);"><font face="Palatino"><font size="-1"><a href="mailto:silvia.colasanti@lnf.infn.it">Silvia Colasanti</a>, 2011</font></font></p> </body></html></div> </div> </body>