'Order forms' should be sent to :

Sebastien Destercke, Ph. D.
CNRS researcher in computer science.
Université de Technologie de Compiègne
U.M.R. C.N.R.S. 7253 Heudiasyc
Centre de recherches de Royallieu
F-60205 Compiegne Cedex
FRANCE
Tél : +33 (0)3 44 23 79 85 / Fax : +33 (0)3 44 23 44 77
E-mail : sebastien.destercke@hds.utc.fr

'Order forms' should be made to :

UTC
Service facturier
Bâtiment REE - CS 60319
60203 COMPIEGNE Cedex

N° TVA : FR 07 196 012 231
IBAN : FR76 1007 1600 0000 0010 0806 886BIC : TRPUFRP1

N°SIRET UTC : 196 012 231 00169

Registration Form

( * ) Required Field

Title *: Surname *: Given Name *:

Nationality *:

Institution/Company *: Department/Function *:

Address *:
Zip Code: City *: Country *:

E-mail *: Phone : Mobile :

Rates

Select the rate that applies to youAmount
Normal - Early registration (before May 15th)400,00 €
Student - Early registration (before May 15th)200,00 €
Normal - Late registration (after May 15th)500,00 €
Student - Late registration (after May 15th)250,00 €
Check the boxes which applyAmount
I will participate to the lunch on July 15-
I will participate to the lunch on July 16-
I will participate to the lunch on July 17-
I will participate to the Town hall reception on July 15-
I would like to visit (possibility to be confirmed) the "château de Compiègne" before the banquet on July 16-
I will participate to the banquet diner on July 16-
One accompanying person80,00 €
Second accompanying person80,00 €
Third accompanying person80,00 €
I wish to pay by :

Total :