On-line Registration | Laboratoire Sciences et Méthodes Séparatives

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LAST NAME/FAMILIY NAME *

FIRST NAME *

GENDER *

FEMALE

MALE

ORGANIZATION/COMPANY *

TITLE *

Ms

Mr

Dr

Prof

PROFESSIONAL POSITION *

POSTAL ADRESS *

CITY *

POST CODE/ZIP CODE *

COUNTRY *

PHONE

EMAIL *

FREE COMMENTS

DO YOU INTEND TO PARTICIPATE TO THE FOOTBALL MATCH? *

Yes as a player

Yes as a supporter

No

IF YES, WHICH SIZE FOR YOUR FOOTBALL SHIRT (FURNISHED BY THE ORGANIZING COMMITTEE)?

DO YOU INTEND TO PARTICIPATE TO THE WELCOME PARTY (Sept 5 evening)? *

Yes

No

DO YOU INTEND TO PARTICIPATE TO THE GALA DINNER (Sept 6 evening)? *

Yes

No

!!! No "last minute" inscriptions possible

PAYMENT *

Please specify the method of payment that you would use to pay the registration fee