- REGISTRATION FORM -

For those people who need a formal invitation please contact the LCWS2004 Secretariat.

Inscription date : Wednesday 22 May 2013 Registrant Informations :

Family Name :	First Name :	Title :
Institution :
Mailing Address
Address :
Zip code :	City :
Country :
Phone :	Fax :
Email :

Participation Expenses :

Expenses are mandatory:		110.00 Euros + 35.00 Euros per day:
Which day do you want to eat (35.00 Euros per day):		Monday Tuesday Wednesday Thurday Friday

Number of accompanying persons at Conference dinner (if *none*, put "0"):		at 70.00 Euros

Accompanying person(s) :

Family Name :		First Name :
Family Name :		First Name :
Family Name :		First Name :

Social events (free of charge for registered persons) :

I will attend the welcome reception on the 19th april:	YES NO
I will attend the Conference dinner at the "Sénat" on the 22nd april:	YES NO

Special requirements / vegetarian :

Payment :

Applicants must be able to pay their own participation expenses for be registred. You have to choose between different types of payment. Please select your prefer mode below.

	By credit card (payment in advance)	For this type of payment the original signature is required. You will receive shortly by e-mail a pre-filled application form that we ask you to print, fill and sign.
	By bank transfert (payment in advance)	In euros payable to AGENT COMPTABLE DU CNRS. Bank: Paierie Générale du Trésor, 16, rue Notre-Dame des Victoires, 75097 PARIS CEDEX 02 Bank Code: 30091 Agency: 75200 Account #: 20003000336 Key : 91 OR: IBAN Number: FR76 3009 1752 0020 0030 0033 691 BIC: BDFEFRPPXXX Do not forget to mention the reference: "LCWS2004/IN2P3/59C043". NOTE: bank transfert charges are to be paid by the registrant. Bank transfert copy and registration form should be sent (or fax: 33 1 69 33 30 02) to: LCWS 2004 Secretariat CNRS/IN2P3 LLR Ecole polytechnique 91128 PALAISEAU CEDEX - FRANCE
	By cheque (payment in advance)	In euros payable to AGENT COMPTABLE DU CNRS Cheque should be sent to: LCWS 2004 Secretariat CNRS/IN2P3 LLR Ecole polytechnique 91128 PALAISEAU CEDEX - FRANCE
	CNRS	Only for CNRS or IN2P3 persons: the payment of participation expenses will be made by credit transfer form between laboratories.

Comments :

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