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International Quantum Cascade Laser School and Workshop – Florence

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					     International Quantum Cascade Laser School and Workshop – Florence (Italy)




                                          Registration Form
                            Deadline for early registration June 30th 2010

Participant information

Last name                               First name                                  Title

Organization

Mailing address

Country                                 Phone                                 Fax

E-mail



Registration fees (including Monday to Friday lunches, coffee breaks and conference dinner):
                            Until June 30th 2010          At Villa Finaly           Euro total
Regular                         □ 300 Euros                □ 400 Euros
Students                        □ 200 Euros                □ 300 Euros
Accompanying person             □ 200 Euros                □ 200 Euros

Payment method
Bank transfer to: Villa Finaly, via Bolognese 134/R, 50139 Florence (Italy)

                                            AGT COMPTABLE CHANCELLERIE DES
Account holder                              UNIVERSITES DE PARIS

IIBAN                                       FR7610071750000000100300295

BIC ( Bank identifier Code)                 BDFEFRPPXXX

SWIFT code                                  BDFEFRTPCCT

				
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