REGISTRATION FORM to be returned to: Deadline to Register : September 12, 2007

INRIA - Bureau des Colloques

Monique Simonetti

B.P. 93

06902 Sophia Antipolis Cedex, France

Tel : + 33 (0)4 92 38 78 64 - Fax : + 33 (0)4 92 38 76 33 -

Email : Monique Simonetti@sophia.inria.fr

REGISTRATION FORM

FACS’07

Formal Aspects of Component Software

September 19 -21, 2007

Name .........................................................................………………………………………………………

First Name …......................................……………………………………………………………………..

Affiliation ..........................................................................................................…………………………….

Address....................................................................................................................................................…...

Zip Code ……………………………………………………………………………………………............

City……………………………………………………… Country ……………..............................….......

Tel: ......................................................... Fax: ...........................................................…………………..

Email: ..........................................................................………………………………………………………

REGISTRATION FEES

(VAT 19,60 % included)

ACADEMIC 210,00 € /___/

STUDENT 160,00 € /___/

Extra Banquet 40,00 € /___/

BUS TO THE AIRPORT – Friday September 21st YES /___/ NO /___/

Arrival Date : Departure Date :

PAYMENT

Please cross the appropriate option :

- Bank draft in EUROS to the order of Agent Comptable de l'INRIA send to the address

Above

- Bank transfer to the order of Agent Comptable de l’INRIA through a Purchase order

Bank Name : Trésorerie Générale des Yvelines ,16 Avenue de Saint Cloud, 78018 Versailles, France

ACCOUNT NUMBER  10071 78000 00001006080 - 84

BIC Code : BDFEFRPPXXX

IBAN Code : FR76 1007 1780 0000 0010 0608 084

(Please make sure your name is clearly mentioned with your payment together with the conference name :

FACS’07)

- Credit Card (VISA, EUROCARD – MASTERCARD only accepted )

Please complete and sign the following form :

Name……………………………………….. First Name …………………………

I authorize Inria to debit my Credit Card :

/__/ VISA /__/ EUROCARD/MASTERCARD Amount : /__/__/__/

Card's number :

/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/ Expiration date : /__/__/__/__/

/__/__/__/ (the last three figures at the back of your card : new process to secure the distant payment)

NB : If the registered person has a different name from the credit card owner, the latter should complete the following formula :

I authorize Inria to debit my Credit card for the account of M…………….. …………….

and sign

Cancellation

Fees will be returned in full for any written cancellation received before September 15, 2007 (post marked stamp). No refund will be made for cancellation received after this date.

Date : Signature :