AAR Short Course - Paris Sept. 15, 2009

On 15/09/2009

Registration to : AMPERE
Martine Blaimont
42, avenue du Général de Croutte
31100 TOULOUSE
(33)5 34 63 84 10
(33)5 61 40 01 08
inscription@ampere-asso.net

Title*
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First name*
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The registration fees include proceedings, coffee-breaks, lunches and gala dinner. Only registration accompanied by payment will be processed.

Registration fees ( before August 31th, 09)

Regular - 450 EUR

Student - 250 EUR

Total to be paid

EUR

A receipt will be sent as soon as this form and the payment wil be received. For payment by credit card, you will have to fill a form on next page.

Means of payment	Purchase order
Organization
Invoicing address*


Zip code*
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Means of transport

Payments for the registration fees are to be sent, in EUROS :

   · by administrative order to AMPERE,
   · by check, drawn on a French bank, made out to AMPERE,
   · by wire transfer : account n° 10268 - 02504 - 12719500200 - 49
     IBAN : FR76 1026 8025 0412 7195 0020 049 - BIC : COURFR2T
     Banque COURTOIS,    33, rue de Rémusat,    31000 TOULOUSE.

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