4th International Workshop on
THERMAL INVESTIGATIONS of ICs and MICROSTRUCTURES

WORKSHOP REGISTRATION FORM

(Please circle) IEEE Member Non Member
ADVANCE REGISTRATION
(before 4 September 1998) 		2 500FF 2 800FF
LATE/ON-SITE REGISTRATION
(after 4 September 1998) 		2 900FF 3 200FF

Please use BLOCK CAPITALS.
IEEE N°: __________________________
Last Name: ______________________________________________________________
First Name: ______________________________________________________________
Organisation: ______________________________________________________________
Address: ______________________________________________________________
______________________________________________________________
Country: ______________________________________________________________
Tel. N°: __________________________ Fax N°: __________________________
E-mail: __________________________

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 THERM98-B0706

  Cadre    by VISA credit card (SA UNIVAL):
VISA Credit Card N°
















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 28 and 29 September, the banquet on 28 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 27 September, and a cost of 330FF for the banquet on 28 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