Registration form must be returned to Europa Organisation

EDCC-4 -
Parc des Expositions - Toulouse – 23th to 25th October, 2002
Registration form must be returned to Europa Organisation
5, rue Saint Pantaléon - BP 844 - 31015 Toulouse Cedex 6 - FRANCE
Tél.: + 33 (0) 5 34 45 26 45 - Fax: + 33 (0)5 34 45 26 46/47 - E-mail: [email protected]
Title : ❐ Ms
❐ Mrs
❐ Mr
Family Name : .......................................................................................... First name : .................................................................................
Institution / Company :.....................................................................................................................................................................................
Address : .............................................................................................................................................................................................................
Zip code: ................................................ City : ....................................................................... Country : .......................................................
Phone : ............................................... Fax : .......................................................... Email : ..............................................................................
REGISTRATION
Before September 20th, 2002
After September 20th, 2002
Registration fees
Full Registration
400,00 €uros
480,00 €uros
.………………………€ VAT Included
Student
Registration*
200,00 €uros
240,00 €uros
.………………………€ VAT Included
TOTAL :
.………………………€ VAT Included
*A proof of student status must be attached
GALA DINNER
Evening at the “Cité de l’Espace” on Thursday, October 24th, 2002 :
I will participate :
❐ YES
❐ NO
TRANSPORTATION
Air France, Air Lib and SNCF (French Railways) companies offer a special « congress » rate (up to 50% reduction)
on flights or roads lines from October 12th, 2002 to November 2nd, 2002 to attendees producing the rebate
vouchers.
❐ Please, send me the SNCF Rebate voucher.
For flights please refer to the information on the web site (http://www.laas.fr/edcc-4/transportation.html).
PAYMENT
❐ By Cheque (in Euros only) to the order of "CCIT/Service SITEF".
❐ By Credit card :
I undersigned, M _ __ _ _ _ _ _ _ _ authorize Europa Organisation to debit the sum of €_ _ _ _ _
on my credit card.
❐ American Express
N° :
❐ Diners
❐ Visa Card/Eurocard/Mastercard
Expiry date:
(it is compulsory)
/
Month
Date : ......................................................Signature (it is compulsory) :
For registration form sent without payment, thank you for sending us an original order form.
An invoice will be sent to you and you will be able to pay by bank transfer (bank details mentioned on the invoice).
For any payment by bank transfer, it is necessary to send us the copy of the order of transfer and to indicate in
reference of the transfer the number of the invoice.
Registration fees cover admission to the conference, conference proceedings, coffee breaks and lunches, welcome
reception at Grand Hôtel de l’Opéra, and evening at “Cité de l’Espace”.
Cancellations: cancellations should be notified in writing to Europa Organisation (mail of fax).
Refund of 50% will be made if a written request is received before September 22, 2002.
No refund can be made for cancellation received after September 22, 2002.
Date : ......................................................Signature (it is compulsory) :
Year