Seventh Workshop on « Spatial Econometrics and Statistics

Seventh Workshop on « Spatial Econometrics and Statistics »
9-10 June, 2008. Paris.
Registration Form
Last Name: ……………………………………
First Name: …………………………………..
Student or Post-doctoral position (Yes / No): ……………………………………………………………
Institution: ………………………………………………………………………………………………..
Address: ………………………………………………………………………………………………….
City: ………………………………………….
ZIP code: ……………………………………..
Country:………………………………………………………......………………………………………
E-mail: …………………………………………………………………………………………………...
Registration fees (taxes included)
Permanent position:
80 €
Student or Post-doctoral position:
40 €
Registration fees include admission to the scientific sessions, and a copy of the conference abstracts as
well as, coffee breaks, dinner on Monday evening and lunch on Tuesday.
Means of payment:
Credit Card
ˆ
Bank Transfer ˆ
Payment of registration fees (net of charges) may be made by credit card or bank transfer. Payment
must accompany this Registration Form. You will be registered for the workshop when full payment is
received.
1- Payment by Credit Card
Credit card / Carte de crédit (VISA/ MASTERCARD/ …) : …………………………………….
Card Number / Numéro de carte:
Expiration date (Month/Year) /date d’expiration (Mois/Année) :
Card holder's Family name / Nom du détenteur :……………………………………………..
First Name / Prénom : …………………………………………………………………………
Address / Adresse : ……………………………………………………………………………
I Hereby authorize l'Agent Comptable de l'INRA de Versailles to debit my credit card for an
amount of ……... Euros
Date
Signature
2- Bank Transfer to the following bank account (please specify « Spatial Econometrics Workshop,
UMR Economie Publique»)
BENEFICIARY
Name : AGENCE COMPTABLE INRA VERSAILLES
Address : ROUTE DE SAINT CYR –78026 VERSAILLES – CEDEX
Country: France
IBAN: FR76-1007-1780-0000-0010-0398-079
Location: TRESOR GENERALE des YVELINES
BANKING INFORMATION
Name of Bank : TRESOR PUBLIC-TRESORERIE GENERALE DES YVELINES –
Bank Code: 10071 - 78000
Bank Identification
Code: BDFEFRPPXXX
Country: FRANCE
Please post or fax the registration form to:
Sylvie LA MANTIA,
UMR INRA-AgroParisTech – Economie Publique,
Avenue Lucien Brétignières, BP01, 78850 THIVERVAL-GRIGNON, France.
Fax: +33 / (0)1 30 81 53 68.
An invoice will be sent to you in upon receiving your registration form with payment.
Please detail the address to whom the invoice should be sent: