THERMINIC REGISTRATION FORM | 
|
THERMINIC REGISTRATION FORM |
|
WORKSHOP
(Please, mark your selection clearly)
| IEEE MEMBER
| Non Member
| ADVANCE REGISTRATION | (received before 10 September 1999) 450 Euro
| 500 Euro
| LATE/ON-SITE REGISTRATION | (after 10 September 1999) 500 Euro
| 560 Euro
| | ||
TUTORIALS
You must select one (Please circle) -
| Tutorial A
| Tutorial B
| ADVANCE REGISTRATION | (received before 10 September 1999) 250 Euro
| 250 Euro
| LATE/ON-SITE REGISTRATION | (after 10 September 1999) 300 Euro
| 300 Euro
| | ||
IEEE N°: __________________________
Please use BLOCK CAPITALS.
| Last Name: | ______________________________________________________________ |
| First Name: | ______________________________________________________________ |
| Organisation: | ______________________________________________________________ |
| Address: | ______________________________________________________________ |
| ______________________________________________________________ | |
| Country: | ______________________________________________________________ |
| Tel. N°: | __________________________ | Fax N°: | __________________________ |
| E-mail: | __________________________ |
They are 3 ways to pay the registration fee (tick one):
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 THERM99-B0706 |
by VISA card/ Eurocard/ Mastercard (SA UNIVAL):
| Credit Card N° | |||||||||||||||||
| Expiry Date: |
| Name of Cardholder: . . . . . . . . . . . . . . . . . . . | Total in Euro: . . . . . . . . . . . . . . . . . . . |
Date / Signature:
on site:
| On site payment will only be accepted with VISA credit card/ Eurocard/ Mastercard payment in Euro. |
The Workshop registration fee includes the welcome reception, the lunches on 4, 5 and 6 October, the diner on 5 October, the coffee breaks, and a copy of the informal Proceedings.
A cost of 34 Euro will be charged for accompanying persons for the welcome reception on 4 October, and a cost of 45 Euro for the diner on 5 October. If you require, please indicate the number of accompanying persons and add the corresponding amount to the payment:
accompanying persons at the welcome reception,
accompanying persons at the diner.
Tick here if you wish vegetarian meals.
The Tutorial registration fee includes the lunch and the coffee breaks on 3 october and a copy of the hand-outs.