APPEL A COMMUNICATIONS by lifemate

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									                                                             Reply Form

NAME :                                                                          First name :
Institution :
Mailing address :
Zip code and city :
Country :
Phone :                                        Fax :                             Email :


     - I submit an abstract:                                                                                 /______/
     Title of abstract:


     - and I register now :                                                                             /______ /
     - I register but I do not submit an abstract :                                                     /______ /


 Easy ways for payment :
     I register before July 30 th /__/                           After July 30 th /__/
-    Check in favor of Auredi :
     Enclosed is a check of                /_____/ FF
     A check of           /_____/ FF is sent separately (if e-mail registration)
-    Bank transfer to : AUREDI
International Banking Account Number (BAN) : FR 76 16806001003923769900012
Bank IDENTIFICATION CODE BIC : AGRIFRPP868 (Clermont Salins)
Bank address : Crédit Agricole
3, avenue de la Libération,
63045 Clermont-Ferrrand Cedex 9, France

(Please make sure that “Conference” is mentioned on the order of transfer).

Hotel reservation (around 500 FF and 400 FF per night with breakfast respectively for class A and B
hotels) will be made on request. Further information will be provided later on.
/__/ I wish to receive an hotel registration form.


                      Reply form and cheque to be returned to: CERDI, “Colloque santé, November 2000”
                                      65, Bd. F. Mitterrand, 63000 Clermont-Ferrand, France

                       Abstracts must be sent by mail or e-mail to Odette Guillot, Conference secretariat.

								
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