ICSEA '98
INDIVIDUAL REGISTRATION FORM
Please use one form per person
Form to be returned
by post mail :
CNAM - CMSL
292, rue Saint-Martin
75003 PARIS - FRANCE
or Fax :
+ 33 ( 0 ) 1 40 27 23 77
Ms [ ] Mr [ ]
Last Name :
First Name :
Title :
Organization :
Address :
Postal/Zip code :
City :
Country :
Phone :
Fax :
Email :
Please tick as appropriate |
Standard fee* | University fee* | Student fee* |
3 days |
FF 4 600 [ ] | FF 2 600 [ ] | FF 600 [ ] |
2 days |
FF 3 500 [ ] | FF 2 000 [ ] | FF 400 [ ] |
1 day |
FF 2 000 [ ] | FF 1 200 [ ] | FF 300 [ ] |
| Proceedings | FF 300 [ ] |
||
| Lunches | Tuesday 8 FF 150 [ ] |
Wednesday 9 FF 150 [ ] |
Thursday 10 FF 150 [ ] |
| Total | |||
* VAT Include
I plan to attend the following sessions
( please tick as appropriate )
| 1 [ ] | 2 [ ] | 3 [ ] | 4 [ ] | 5 [ ] | 6 [ ] | 7 [ ] | 8 [ ] |
| 9 [ ] | 10 [ ] | 11 [ ] | 12 [ ] | 13 [ ] | 14 [ ] | 15 [ ] | 16 [ ] |
Tranportation discount
I would like to receive:
[ ] The French Railways ( SNCF ) discount form
[ ] The Air France discount form - Agreement n° SC24862
PAYMENT
ONLY THOSE APPLICATIONS RECEIVED WITH PAYMENT ENCLOSED WILL BE HONOURED
Please find enclosed a check payable to Agent Comptable du Conservatoire des Arts et Métiers in the amount of FF ..........................
corresponding to the amount mentioned above
Please transfer to the account :
30041 00001 0906301R020 13
Swift 40 46-2
Réf : BDF EFRPT-CCT
Please inform your bank that the transfer fees are to be paid by the issuer, and
bring a copy of the Swift transfer with you
Date.......................................................Signature