MODULO DI ISCRIZIONE / SUBSCRIPTION FORM Terzo interconfronto internazionale radon in campo per sistemi di misura passivi / III° International in the field intercomparison exercise for passive radon detectors DATI DEL LABORATORIO/ LAB DATA (I)Informazioni generali (*campi obbligatori) / General information (fields marked with * are required) Laboratory name:* Contact person:* E-mail:* Telephone (w/ country code):* Area Code - Phone Number Address:* Street Address Street Address Line 2 City State / Province / Region Zip Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Brazzaville)Costa RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe CountryDATI DEL LABORATORIO/ LAB DATA (II) Invoice needed?:*YesNo Company* Company Address:* Company Street Address Company Street Address Line 2 Company city Company State / Province / Region Company Zip Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Brazzaville)Costa RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Company Country Tel.: Area Code - Phone Number VAT number:* Codice univoco SDI (obbligatorio per partecipanti italiani):NUMERO DI SET / NUMBER OF SETSScegliere il numero di set di dosimetri da esporre (IVA 22% inclusa) / Choose the number of dosemeters sets to be exposed (VAT 22% included) N° Sets:*1 set: 305€2 sets: 524.60€3 sets: 744.20€SET ITipo di dispositivo (*campi obbligatori) / Type of detector(fields marked with * are required) Name of device:(I)* Detector (type and manufacturer):(I)* Holder type:(I)* Analysis System:(I)*HomemadeCommercial Commercial system name:(I) Device is closed (a diffusion barrier is present):(I)*YesNo ON/OFF system:(I)*YesNo Device is fitted with protection against humidity:(I)*YesNo Which kind of humidity barrier?:(I)Solo nel caso di utilizzo di Elettrete / Only for electret detectors Chamber Type:(I) Electret type:(I) Altitude correction:(I)YesNo Gamma correction:(I)Yes, evaluatedYes, measuredNo How?:(I)Ai fini dell’analisi dei risultati, si prega di fornire le seguenti informazioni aggiuntive / Additional information needed for analysis: System accreditation:(I) Frequency:(I) N. of exposures:(I) Exposure range (kBq•h/m³):(I) Typical uncertainty %:(I) Additional notes:(I)SET IITipo di dispositivo (*campi obbligatori) / Type of detector(fields marked with * are required) Name of device:(II)* Detector (type and manufacturer):(II)* Holder type:(II)* Analysis System:(II)*HomemadeCommercial Commercial system name:(II) Device is closed (a diffusion barrier is present):(II)*YesNo ON/OFF system:(II)*YesNo Device is fitted with protection against humidity:(II)*YesNo Which kind of humidity barrier?:(II)Solo nel caso di utilizzo di Elettrete / Only for electret detectors Chamber type:(II) Electret type:(II) Altitude correction:(II)YesNo Gamma correction:(II)Yes, evaluatedYes, measuredNo How?:(II)Ai fini dell’analisi dei risultati, si prega di fornire le seguenti informazioni aggiuntive / Additional information needed for analysis: System accreditation:(II) Frequency:(II) N. of exposures:(II) Exposure range (kBq•h/m³):(II) Typical uncertainty %:(II) Additional notes:(II)SET IIITipo di dispositivo (*campi obbligatori) / Type of detector(fields marked with * are required) Name of device:(III)* Detector (type and manufacturer):(III)* Holder type:(III)* Analysis System:(III)*HomemadeCommercial Commercial system name:(III) Device is closed (a diffusion barrier is present):(III)*YesNo ON/OFF system:(III)*YesNo Device is fitted with protection against humidity:(III)*YesNo Which kind of humidity barrier?:(III)Solo nel caso di utilizzo di Elettrete / Only for electret detectors Chamber type:(III) Electret type:(III) Altitude correction:(III)YesNo Gamma correction:(III)Yes, evaluatedYes, measuredNo How?:(III)Ai fini dell’analisi dei risultati, si prega di fornire le seguenti informazioni aggiuntive / Additional information needed for analysis: System accreditation:(III) Frequency:(III) N. of exposures:(III) Exposure range (kBq•h/m³):(III) Typical uncertainty %:(III) Additional notes:(III)CHECKOUT E INVIO DATI /CHECKOUT AND DATA SUBMISSIONQuota d’iscrizionePer il primo set di dispositivi: 250 euro + IVA 22% Per il secondo e il terzo set di dispositivi: 180 euro + IVA 22% da corrispondere entro il 15 settembre 2019 tramite bonifico bancario a: AIRP c/o Intesa Sanpaolo S.p.A. Filiale di Milano, Piazza Paolo Ferrari, 10 - 20121 Milano – Italy, IBAN IT29N0306909606100000125788, BIC BCITITMM, Causale: “IcRn2019 Milano”IMPORTANTE: l’iscrizione deve essere convalidata con la restituzione del modulo “termini e condizioni di partecipazione” firmato e datato all’indirizzo radon@airp-asso.itSi prega di controllare la cartella spam della casella di posta in caso non si riceva una mail di conferma dopo la registrazione. Si consiglia di stampare la pagina riassuntiva che comparirà dopo l'invio del presente moduloFees First set of devices: 250 euro + VAT 22% Second and Third set of devices: 180 euro + VAT 22% to be paid before 15th September 2019 through a Bank Transfer to the following Bank Account: AIRP c/o Intesa Sanpaolo S.p.A. Filiale di Milano, Piazza Paolo Ferrari, 10 - 20121 Milano – Italy, IBAN IT29N0306909606100000125788, BIC BCITITMM, Purpose: “IcRn2019 Milano”IMPORTANT: the application must be validated returning the following form “terms and conditions” signed and dated to: radon@airp-asso.itPlease, check out your spam folder if you don't receive a confirmation mail after registration. It is advisable to print the summary page that will appear after sending this form.Invia / SubmitReset
