Email Address

First Name

Last Name

Academic Position

Institutional Affiliation

Address (Please include: Street, City, Postal Code, Country)

Are you an AISNA member?
YesNo

Will you be attending the conference dinner on Friday, September 22? YesNo

If you'll be attending the conference dinner, please list your dietary restrictions

Will you be attending the Narni Underground guided tour on Saturday September 23 at 3pm? The visit will last approximately an hour and it is unfortunately not accessible to people with limited mobility and/or physically disabilities. The €7 participation fee will be collected in loco. YesNo

Amount Paid
€100 (Non-Tenured/Unemployed AND Under 40; AISNA Member WITH dinner)€120 (Non-Tenured/Unemployed AND Under 40; Non AISNA Member WITH dinner)€150 (Tenured/Over 40; AISNA Member WITH dinner)€170 (Tenured/Over 40; Non AISNA Member WITH dinner)€50 (Non-Tenured/Unemployed AND Under 40; AISNA Member)€70 (Non-Tenured/Unemployed AND Under 40; Non AISNA Member)€100 (Tenured/Over 40; AISNA Member)€120 (Tenured/Over 40; Non AISNA Member)

Will you need wi-fi access? (If so will be required to upload your ID in order to create a guest account)
YesNo

Payment Information

Bank

Date

Name of Account Holder

Please upload your receipt