WORKSHOP REGISTRATION FORM

 Cadre   2800FF for non-IEEE members

 Cadre   2500FF for IEEE member s        IEEE No:

Please use BLOCK CAPITALS

Last Name: .........................................................................................................
First Name: .........................................................................................................
Organisation: .......................................................................................................
Address: ............................................................................................................
.......................................................................................................................
Country: ......................................................
Tel: .............................................. Fax: .............................................
Email: ...............................................................................................

They are 3 ways to pay the registration fee (tick one):

 Cadre    payment to:

Madame l'Agent Comptable Secondaire du CNRS, Délégation Alpes, CNRS, 25, avenue des Martyrs, BP 166X, 38042 GRENOBLE Cedex, FRANCE,
by cheque or bank transfer to the following account number:
Bank: TRESOR PUBLIC Grenoble 10071-38000-00003000056-07, mentioning THERMINIC97-B0706

 Cadre    by VISA credit card (SA UNIVAL):

VISA Credit Card Ndeg.
















Expiry Date:




Address of Cardholder:

Total: . . . . . . . . . . . . . FF

Date / Signature:

 Cadre    on site:

On site payment will only be accepted with VISA credit card payment in FF.

The Workshop registration fee includes the welcome cocktail, the lunches on 22 and 23 September, the banquet on 22 September, the coffee breaks, and a copy of the informal Proceedings.
A cost of 120FF will be charged for accompanying persons for the welcome cocktail on 21 September, and a cost of 330FF for the banquet on 22 September. If you require, please indicate the number of accompanying persons and add the corresponding amount to the payment:

  Cadre    accompanying persons at the welcome cocktail,

  Cadre    accompanying persons at the banquet,

  Cadre    tick here if you wish vegetarian meals.

The form is to be returned to:
THERMINIC Workshop
TIMA
46, avenue Félix Viallet
38031 GRENOBLE cedex 1
FRANCE
Fax : +33 4 76 47 38 14