GAATI - IML

REGISTRATION FORM

Registration fee: 100 Euro

Bank transfer to: Association AMP
Bank code: 12179 (Banque de Polynésie)
Agence code: 06730
Account number: 30001747960

Caution: you have to transfer by your own means (no dead line)

PERSONAL DATA

SURNAME (family)
FIRST NAME
CITIZENSHIP
MALE / FEMALE
HOME PHONE NUMBER
PROFESSIONAL INFORMATION
POSITION
INSTITUTION
DEPARTMENT
STREET
CITY
COUNTRY
OFFICE PHONE NUMBER
FAX
WEB ADDRESS
ACCOMMODATION
DATE OF ARRIVAL
DATE OF DEPARTURE
WILL YOU STAY AT SHERATON HOTEL ?
E-MAIL
POSSIBLY NOTE YOUR SPECIAL REQUESTS (food, accommodation,...)

Nota: Accommodation is not included in the registration fee. You pay the bill directly to the hotel.
EXCURSION

Day excursion: 9th of may 2007, wednesday.
Place: Moorea Island
Price : 20 Euro per person (excursion + lunch)

IF YOU INTEND TO PARTICIPATE TO THE EXCURSION, PLEASE PRECISE THE NUMBER OF PERSONS ACCOMPANYING (THAT INCLUDE YOU)

If you want to change registration data, please send a mail to saga2007@iml.univ-mrs.fr