Registration Form Yacc 2012

DO NOT FORGET TO SEND BY FAX ( 33.494.14.2633 ) A COPY OF YOUR BANK TRANSFER
* : required fields

Deadline for registration: Monday, August 20, 2012.

Payment by:

Last name*:

First name*:

Position / title:

Affiliation:

Address:

Country:

E-Mail* :

Phone:

Fax:

According to the number of participants, it could happen that not enough single room would be available. In this event would you agree to share your room ?
yesno

If, yes choose double room and eventually, roommate's name:

Are you vegetarian ? yesno

Arrival:
Thank you to specify your presence at lunch (arrival before or after lunch) : Before lunchAfter lunch

Departure:
Thank you to specify your presence at lunch (departure before or after lunch) : Before lunchAfter lunch

Do you plan to submit a talk ?
yesno

Comments, questions:

Thank you to reproduce the text from the image above before submitting the form:
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