Agent comptable secondaire de l'INRA Versailles
INRA Versailles,
Service déconcentré d'appui à la recherche
Route de Saint-Cyr, 78026 Versailles Cedex, France
Fax: +33 1 30 83 37 87
E-mail: darthout@versailles.inra.fr
PLEASE, USE CAPITAL LETTERS TO FILL THIS FORM
Surname: First Name:
Affiliation:
Mailing address:
Zip Code: City: Country:
Phone: E-mail:
Registration Fee:
Before May 15 , 2005 |
After May 15 , 2005
¨ |
||
c Ordinary participants | 170 € | c All participants: | 200 € |
c ESSC/AFES members: | 150 € | ||
c Ph.D. Students: | 100 € |
By Credit Card
c Visa c Eurocard c Card Mastercard
Expiration date: |
Card number: |
Cardholder's surname: First Name:
Address:
I hereby authorize the Agent Comptable secondaire INRA to debit my credit card with the registration fee as quoted above for an amount of €.
Date : Signature :
By Bank Draft
Important: the payer supports all bank fees. Please give your name in your draft order when you will specify the reason of payment and send us a copy of this draft order, joined to your reservation request.
Name: INRA Versailles Agence Comptable secondaire
Address: Route de Saint-Cyr, 78026 Versailles Cedex, France
Bank Name: TP VERSAILLES
Agency Code: 10071
Desk Code: 78000
Account number 00001003980
RIB Key: 79
IBAN: FR76 1007 1780 0000 0010 0398 079
BIC: BDFEFRPPXXX