To the edge of the universe - Registration form

Conference "To the edge of the universe"- 30 years of IRAM

Registration form to be filled in and sent to IRAM before September 1^st, 2009

Title	Mr	Dr
	Ms	Prof

First Name
Family Name
Institute
Address
Phone
E-mail

Conference registration details

How many days will you stay?	3 days
	2 days	first day:	last day:	September 2009
	1 day	the:	September 2009

Participation at the reception cocktail on Monday evening: yes no

Participation at the conference dinner on Tuesday evening: yes no

Conference registration fee

The conference fees are 100€ per person (this includes the Monday evening cocktail,
the Tuesday evening conference dinner and morning /afternoon refreshments during the conference).
This fee should be paid preferably by bank transfer. Please use the following information:

IBAN:	FR76 1390 6000 4343 1262 6000 055
Name of Bank:	CREDIT AGRICOLE SUD RHONE ALPES
Bank code:	13906
Agency code:	00043
Account number:	4312626000055
Bank address:	15 rue Paul Claudel, F 38100 GRENOBLE
BIC Code:	AGRIFRPP839

Please indicate:	1) your name
	2) "IRAM 30 years registration fee"

If needed, the conference fee can also be paid during the conference (only cash).

Contributed Papers and Poster Session:

I would like to contribute a paper:	yes no
If yes,
title of the paper:
abstract:

I would like to present a poster:	yes no
If yes,,
title of the poster:
abstract: