Registration for Hybrid & Electric Vehicles Matchmaking Event – Stezzano, July 2-3, 2012

1. Registration Form AutoNet 7th Match making eventHybrid and electric vehicles and components 2- 3 July 2012 Stezzano, Bergamo • Please fill in this form and send it via email by 22 JUNE to: • michelacavallini@michela.e.telefonica.net • Date of arrival and date of departure: Participant1............................................................/................................................................ Participant2....................................................../.............................................................. I authorise, according to Italian Privacy Law n. 675/96 art. 10 and n. 695/96 art. 13, the tratement of my personal data to the only scope of the registration to the above-mentioned event. These data will be archived by the event management company. Company/Organisation Name: ………….. Address: ……….. Country:………………….. Participant 1 and function: ………………….. Participant 2 and function: ……………………… Tel.: ……………………………………………………………Fax:…………………………………………………………..e-mail: ……………………. Contact mobile.: .................................................................................................................... • 3 July – Matchmaking • Yes/No…… Participant 1…………………………………………………......................... • Yes/No…… Participant 2………………………………………………………...................... • 2 July – site visit to BREMBO Spa • Yes/No……Participant 1……………………………………......................................... • Yes/No…….Participant 2……………………………………………………………………………… • 3 July – Plenary session • Yes/No……Participant 1……………………………………………………………………................. • Yes/No……Participant 2…………………………………………………………………………… • 3 July – Get-together dinner • Yes/No……Participant 1…………………………………………………………………….. • Yes/No……Participant 2…………………………………………………………………….. ………………………………………….. ………………………………………………….. Date Signature Contact Mic hela Cavallini Ph. +34 634341199 michelacavallini@michela.e.telefinica.net