HIF06 - Registration Form

Saint Malo, July 9-14, 2006 hif06.lpgp.u-psud.fr

contact: Marie-Madeleine Gombert, hif06.pgp@lpgp.u-psud.fr

title*
first name*
last name* 
(family name)
institution*
e-mail*
postal address:
(with the name of your Institute or Laboratory)
street, no, etc... *
zip code *
city *
country *
phone
fax
registration type *
normal student (Students have to give an attestation of their institute or laboratory. A"post-doc" is not a student)
(until april 14, NO MORE AVAILABLE!) late registration (after april 14)
I plan to submit a contribution *
No
Yes - please send abstract before March 3rd
Title:
I would prefer: an oral presentation a poster
I will come to the conference banquet *(on wednesday evening)
Yes (for the participants at the Conference the banquet is included in the registration)
I also subscribe for accompanying persons (40€ each) # of persons
Special requirements, vegetarian...
No
Tour to Mont Saint-Michel *(on wednesday afternoon, not included in the registration)
Yes (not included in the registration, 38€)
I also subscribe for accompanying persons (38€ each) # of persons
No
(for persons working in France only) *
Are you a CNRS employee? Yes
No

(if able to answer)
When do you plan to...

arrive in Saint-Malo? july//2006 and to leave Saint-Malo? july//2006

(if able to answer)
Method of payment *

Bank transfer in € (Euros) payable to:
AGENT COMPTABLE SECONDAIRE ILE DE FRANCE SUD
Bank:
Trésorerie générale de l'Essonne, 27 rue des Mazieres, 91011 EVRY Cedex 3 - FRANCE
Bank code: 10071
Agency: 91000
Account #: 00001001722 Key: 33
IBAN: FR76 1007 1910 0000 0010 0172 233
BIC: BDFEFR PPXXX
Do not forget to mention the reference: "HIF06"
Bank transfer charges must be sent by mail or fax to:

HIF06
- M. Dessaints
LPGP, bat 210
, Université Paris Sud
91405 Orsay - France
fax: +33 1 69 15 78 44

Bank cheque payable in € (Euros) (from a bank account in France) written out to:
"AGENT COMPTABLE SECONDAIRE ILE DE FRANCE SUD". Cheque must be sent to:

AGENT COMPTABLE SECONDAIRE ILE DE FRANCE SUD
Trésorerie générale de l'Essonne
27 rue des Mazieres
91011 EVRY Cedex 3 - FRANCE

Copy of cheque must be sent by mail or fax to:

HIF06 - M. Dessaints
LPGP, bat 210, Université Paris Sud
91405 Orsay - France
fax: +33 1 69 15 78 44
Credit card.
For this type of payment the original signature is requiered.
Please print an application form from the HIF06 site, fill it in with exact amount (in € (Euro)), sign it and send it via classic postal mail (no fax please for confidentiality) to:

HIF06
- M. Dessaints
LPGP, bat 210
, Université Paris Sud
91405 Orsay - France
Only for CNRS persons:
The payment of participation fees can be made by credit transfer form between laboratories (possible only for CNRS laboratories)
  Cash: the payment of participation fees in cash is not possible for legal reasons.

I really don't know yet.
Any remarks?...

 

Payment detail: (automatically filled from your choices above)

registration type ( ):
Conference banquet for accompanying persons ( extra persons):
Tour to Mont Saint-Michel ( persons including myself):
Total:

(* mandatory elements)
Once filled, please print this form before subscribe, for your personal records.
If you pay later, note that the registration fee will increase after april 14.

Reimbursesement of inscription fees is possible if cancelation is notified before June 21.

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