Please read the information brochure, then type/print clearly and send to:
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
City______________________ Zip-Code_____________ Country__________________
==================== FEES / PAYMENT / GRANTS====================
Registration Fees (3 days all included):
* Meals (breakfast -11 & 12-, lunch -10,11,12-, dinner -10-)
* Hotel Accomodation for 2 Nights - 10 & 11-
* Social Event and Conference Dinner -11-.
Daily Registration Fees:
Regular Fee/Student Fee
(3 days all included) 3600 FF / 2960 FF
regular/student 1000 FF / 800 FF
Single room : add 400 FF to the fee.
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
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
* Confirmation of your registration will be send to you by e-mail.