OPODIS'97 Registration Form

 Please read the information brochure, then type/print clearly and send to:

OPODIS'97
LaRIA
5 rue du Moulin Neuf, 80 000 Amiens, France
Fax: 33 3 22 82 76 54 form abroad, 03 22 82 76 54 from France.
 
 

First Name_______________ Last Name__________________________ [ ] Ms [ ] Mr

Affiliation________________________________________________________________

Address____________________________________________________________________

City______________________ Zip-Code_____________ Country__________________

E-mail_________________________ URL________________________________________

Phone__________________________ Fax________________________________________

==================== FEES / PAYMENT / GRANTS====================

Registration Fees (3 days all included):

   * Proceedings
   * Meals (breakfast -11 & 12-, lunch -10,11,12-, dinner -10-)
   * Hotel Accomodation for 2 Nights - 10 & 11-
   * Breaks
   * Social Event and Conference Dinner -11-.

Daily Registration Fees:

   * Proceedings
   * Lunch
   * Breaks
 

                          
 Regular Fee/Student Fee
 (3 days all included)     3600 FF / 2960 FF        
 Daily Fee
 regular/student          1000 FF / 800 FF         
Single room : add 400 FF to the fee.

Your choice:
regular [ ]         student [ ]
3 days all include    [ ]
1 day                 [ ] , precise date :_____________

Room:     [ ] single
          [ ] 2-bedded, sharing with___________________________________________
          [ ] 2-bedded; please find for me someone to share the room with
(change estimation: 1US$=6FF)
 

Amount Paying: _________

Way of Payment (**)(please check one):
(**) Change fees will be paid by the participant.

[ ] By check payable to VERNE-ADER

[ ] By administration order form to VERNE-ADER:
                        UPJV-Chemin du Thil-80025 Amiens Cedex 1-France

[ ] By direct BankTransfer on the account:
                        Credit Lyonnais Amiens 30002/05024/0000079046K20

Please make sure that:

   * the exact amount in FF of your registration fee reaches the above
     account after bank charges
   * all the information above is present in the transfer (to avoid
     unnecessary bank charges)
   * your name and "OPODIS'97" appear clearly on the bank transfer order
   * you fax or send a photocopy of the administration order or the
     transfert order to OPODIS adress.

Cancellations: There will be a fee of 1200 FF applied to cancellation
requests received by November 24th. No refunds will be made to cancellations
that are received later. In all the above cases you will receive the
proceedings volume by mail.

==================== MEALS ==========================
Do you prefer vegetarian meals?                        [ ] Yes        [ ] No
 
 

Please note that:

   * The early registration deadline is November 15, 1997: this is the date
     that we must have received your registration and payment (or proof of
     payment).
   * Confirmation of your registration will be send to you by e-mail.
 
 

Date__________________________ Signature____________________________________