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CONFERENCE FEMISE 2009
Brussels (Belgium), 14-15 November 2009
Registration Form
- Please fill out one form for each participant -
Votre institut est membre du Femise? / Is your Insitute Member of FEMISE?
Pays / Country
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Autre Pays / Other Country
Transport / Means of Transport
Des billets aller-retour au tarif économique vous seront adressés (retour le lundi 16 novembre). Toute modification de votre part sera à votre charge.
Please note that tickets (round-trip economy class) will be directly purchased and sent to you (Return date : Monday, November 16, 2009). You will be responsible for any extra charge if you make changes to your travel plans.
Date de départ / Date of departure
Heure de départ souhaitée / Requested time of departure.
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Date de retour / Date of Return
Heure de retour souhaitée / Requested time of return.
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Quels jours serez-vous présents? / Which days will you attending ?
Hébergement / Accommodation
Merci de noter que nous prendrons en charge 3 nuits au maximum. Toute prolongation sera à votre charge. / You are kindly reminded that we will take in charge three nights maximum, any extensions to your stay will be taken in charge by you.
Réservation hôtelière? / I need a hotel accommodation on?
Informations supplémentaires que vous souhaitez indiquer/Other information you want to indicate
Merci de remplir ce bulletin avant le 26 octobre 2009 - Please fill in this form before the 26th of October
Contact: Viviane BERNADAC PROMO SCIENCES - bernadac@promosciences.com - Tel : 00 33.4.91.91.24.89 - Fax : 00 33.4.91.91.76.83
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