- DELEGATE
 

Mr r

Ms r

Prof r

Dr r

 

SURNAME :	FIRST NAME :.
ORGANIZATION :	OFFICE :
ADDRESS :
Postal Code:               CITY :	COUNTRY :
Tel :	Fax :
E. mail :

- LUNCHES - BANQUET

To facilitate organisation, please fill in the following information
 
 

Monday 22 october 2001	lunch r	Reception at the City Hall r
Tuesday 23 october 2001	lunch r	Banquet r (FF 300)
Wednesday 24 october 2001	lunch r

 

- REGISTRATION FEES

Including conference, lunches, coffee breaks, proceedings and the banquet (except for students)
 

	Before 30/09/01	After 30/09/01
Regular delegate	FF 2 500.00	FF 2 750.00
Academics	FF 1 500.00	FF 1 750.00
Student (banquet not included)	FF 750.00	FF 750.00
Accompanying persons(lunches and coffee only)	FF 360.00	FF 360.00

 

- SETTLEMENT
 

Registration	FF
Banquet : FF 300.00 (students only) x ...pers	FF
TOTAL	FF

VAT Number : ......................................................................................

Please find enclosed :

r cheque or EUROCHEQUE to the order of ILC Pôle Technologique (in french francs).

r Copy of bank transfer send to the account : Crédit Lyonnais Creil-CA-Bank code : 30002 - Desk code : 06227

account number : 0000601271V - key : 19. Please add FF 100.00 to cover transfer charges, if you are paying from outside France.

r I duly authorize you to charge my VISA INTERNATIONAL/EUROCARD/MASTERCARD

card holder’s name :.........................................................

ACCESS N° / / / / / / / / / / / / / / / / /

(date d’expiration /expiration date / )

All payements must be made free of all charges for the beneficiary

- REFUND IN CASE OF CANCELLATION

Cancellation requests received before October 10, 2001 : refund of deposits are subject to a 400 FF processing fee. AfterSeptember 15, 2001 no refund will be made

Date                                                                                           Signature
 
 

please keep a copy of your registration details
 
 

Mr r

Ms r

Prof r

Dr r

SURNAME :	FIRST NAME :.
ORGANIZATION :	OFFICE :
ADDRESS :
Postal Code:               CITY :	COUNTRY :
Tel :	Fax :
E. mail :

please book :
 

	single room	twin room	double room	average price per room and per night
Hôtel hors catégorie				190 FF
Hôtel **				350 FF/380 FF
Hôtel ***				400 FF/450 FF

date of arrival : ........................... date of departure : ..............................................

deposit :
 

standard hotel 190 FF x	nights =	FF
hôtel ** *** 350 FF x	nights =	FF
processing fee		50 FF
TOTAL		FF

Please find enclosed :

r cheque or EUROCHEQUE to the order of ILC Pôle Technologique (in french francs).

r I duly authorize you to charge my VISA INTERNATIONAL/EUROCARD/MASTERCARD

card holder’s name :.........................................................

ACCESS N° / / / / / / / / / / / / / / / / /

(expiration date              /           )

The hôtel deposit will be transferred to the hotel and deducted from your final balance which must be settled before leaving.

Cancellation requests received before October 10, 2001 : refund of deposits are subject to a 50 FF processing fee. After Septembre 15, 2001, no refund will be made

I have duly noted the registration and cancellation regulations and accept the conditions

Date                                                                                              Signature
 
 

please keep a copy of your registration details