Date / Signature:
The Workshop registration fee includes the lunches on 25, 26 and 27 September, the cocktail on 25 September, the banquet on 26 September, the coffee breaks and a copy of the informal Proceedings.
A cost of 55 Euro will be charged for accompanying persons for the banquet on 26 September. If you require, please indicate the number of accompanying persons and add the corresponding amount to the payment:
The Tutorial registration fee includes the lunch on 24 september and a copy of the hand-outs.
Refund policy for preregistration: there is a 50 Euro service charge for processing refunds. Requests for preregistration refunds must be received no later than 7 working days prior to the first day of the Workshop to be honoured. No refunds will be issued after 14 September 2001.
WORKSHOP REGISTRATION FORM
WORKSHOP
(Please circle)
IEEE MEMBER
Non Member
REGISTRATION
(after 1 September 2001)
500 Euro
560 Euro
TUTORIAL (Please circle) A or B
300 Euro
IEEE N°: __________________________
Use BLOCK CAPITALS
Last Name:
______________________________________________________________
First Name:
______________________________________________________________
Organisation:
______________________________________________________________
Address:
______________________________________________________________
______________________________________________________________
Country:
______________________________________________________________
Tel. N°:
__________________________
Fax N°:
__________________________
E-mail:
_______________________________________________________________
Author:
yes
no
Session N°:
They are 3 ways to pay the registration fee (tick one):
by cheque or bank transfer:
Payment to Monsieur 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:
TRESOR PUBLIC Grenoble 10071-38000-00003000056-07, mentioning T1-B0706
by credit card (SA UNIVAL):
Visa Card
Mastercard
Eurocard
American Express
Diners
Credit Card N°
Expiry Date:
Name of Cardholder: . . . . . . . . . . . . . . . . . . . . . . . . .
Total in Euro: . . . . . . . . . . . . on site: payment will only be accepted with credit card payment in Euro.
accompanying persons at the banquet on 26 September.
tick here if you wish vegetarian meals.
Substitutions will be accepted at any stage.
The form is to be returned to: