Registration Form - SWIM 2013 : Small Workshop on Interval Methods

Name :
First Name :
Company/Organization :
Invoicing address :
PostCode :
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Fax :
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Please tick as required :
Workshop SWIM 2013 Free
An invitation letter is required (for visa purposes) Free
Interested by submitting an extended version of your abstract in a special issue of a journal ? Free
LUNCHES - Please book the lunch you will attend below :
Wednesday June 5th 10€
Thursday June 6th 10€
Friday June 7th 10€
Thursday June 6th at 8.30pm
Will attend to the Dinner at the restaurant of Cercle Naval
Free
Please check this box for vegetarian requirement
Room (with breakfast) on the campus (100 meters to the workshop)
Tuesday 11€
Wednesday 11€
Thursday 11€
Your registration will be definitive after payment
Before May 25th

Informations :
Use one registration form by participant and send it with your payment Before May 25th to :
ENSTA Bretagne / Pôle STIC
2 rue François Verny
29806 BREST CEDEX 9

Contact :
☎ (phone) : 00 33 (0)2.98.34.87.40
☏ (fax) : 00 33 (0)2.98.34.89.35
✉ annick.billon-coat@ensta-bretagne.fr

Method of payment :
International banker's cheque made out to "agent comptable de l'ENSTA Bretagne"
Wire transfer or order form : ENSTA Bretagne - Workshop SWIM - 2 rue François Verny 29806 Brest Cedex 9
Account number : 10071 29000 00001002960 66
Domiciliation : TPBREST
IBAN (International Bank Account Number) : FR76 1007 1290 0000 0010 0296 066
BIC (Bank Indentifier Code) : TRPUFRP1
Other

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