ELASTIN 2006 - Registration form.rtf

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					                                        ELASTIN 2006 - Registration form
                         to be sent to:       a.borel@ibcp.fr (DEADLINE June 1st, 2006):

Last name:

First name:

Title:

Position (academic researcher, post-doc, student, …) :

Organisation:

Address:

(State), Zip code & city:

Country:

Phone (preceded by country code):

Fax (preceded by country code):

Email:


Your registration fee :             €


Participation to social events for you (please circle the right item) and your family or accompanying persons (indicate
the number of accompanying persons):

-         1st day lunch, possible between noon and 2:00pm (July 9th):
I will – will not have lunch at the Hôtel-Dieu (included in the registration fees) and I reserve ____ additional lunches for
accompanying persons (20 € each)

-         1st day dinner at "Brasserie Georges" (July 9th):
I will – will not have dinner at Brasserie Georges (included in the registration fees) and I reserve ____ additional dinners for
accompanying persons (30 € each)

-         2nd day evening (July 10th):
I will – will not participate to the cocktail/buffet at Lyon city hall (included in the registration fees) and I reserve ____
additional cocktail/buffet entries for accompanying persons (25 € each)
I will – will not participate to the jazz event (included in the registration fees) and I reserve ____ additional jazz event entries
for accompanying persons (12 € each)

-          3rd day evening at the St Romain en Gal archeological site (July 11th):
I will – will not participate to the trip by boat and visit of the archeological site (included in the registration fees) and I reserve
____ additional trips by boat and visits of the archeological site for accompanying persons (35 € each)
I will – will not have dinner at the archeological museum (included in the registration fees) and I reserve ____ additional
dinners for accompanying persons (20 € each)

-         4th day lunch, 1:00-3:00pm (July 12th):
I will – will not have lunch at the Hôtel-Dieu (included in the registration fees) and I reserve ____ additional lunches for
accompanying persons (20 € each)

If possible, could you tell us:
- when you will arrive at the meeting (day:              ; time:            )
- when you will leave the meeting (day:              ; time:            )
Name(s) of accompanying person(s):

-
-
-
-

Total amount for accompanying person(s) :           €


Total payment (your registration fee + amount for accompanying person(s)) :   €




ELASTIN 2006 - Payment

Important notice:
- please circle your method of payment,
- fill the corresponding part if paying by credit card,
- participants who are not paying by credit card will receive the instructions for payment once
they have registered (invoice, bank account number, address of payment, …).

     Name and firstname of the participant :

     Amount (in euros):



1- Payment by credit card :
Card type (Visa or Mastercard only):
Card number:
Expires (month/year):
Control code (last 3 digits of the number found on the back of the card) :
Name of the card holder:
I hereby authorize the “Agent Comptable Secondaire du CNRS” to charge on my credit card the amount
of              €.
Signature of the card holder:




2- Payment by international wire transfer.
3- Check (in euros only).
4- (For French academic researchers only ) Payment by Administrative Order Form. If possible, CNRS
order forms are preferred. because it will allow us to save the VAT.

				
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