Fields marked with * are mandatory
Family name		*
First name		*
Nationality		*
Address		*
Zip code		*
City		*
Country		*
Organization		*
E-mail		*
Phone number
Your inscription (All Inclusives)		*	Academic/Industrial (500€)  Student (300€)  Workshop only (120€)
Number of additional Gala Dinner (100€/person)		*	0   1   2   3   4   5
Participation			Tuesday - Lunch  Tuesday - Diner  Wednesday - Lunch  Wednesday - Town Tour  Wednesday - Gala Dinner  Thursday - Lunch  Thursday - Cocktail  Friday - Lunch
Type of payment			Bank card  Purchase Orders
Special Diet
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