DTIP2000

DTIP Registration Form

(Please circle)	IEEE or SPIE Member, Author, Committee Member	Non Member
ADVANCE REGISTRATION (received before 14 April 2000)	3000FF / 457,35Euro	3400FF / 518,38Euro
LATE/ON-SITE REGISTRATION (after 14 April 2000)	3400FF / 518,38Euro	3800FF / 579,31Euro

Please use BLOCK CAPITALS

IEEE / SPIE No: ........................................................................................
Last or Family Name: ........................................................................................
First or Given Name: ........................................................................................
Organisation: ........................................................................................
Address: ........................................................................................
........................................................................................
Country: ........................................................................................
Email: ........................................................................................

Tel: .................................................... Fax: ....................................................

There are 3 ways to pay the registration fee (tick one):

by cheque or bank transfer, payment to:
Madame l’Agent Comptable Secondaire du CNRS, Délégation Alpes, CNRS, 25, avenue des Martyrs, BP 166X, 38042 GRENOBLE Cedex, FRANCE, to the following account number:
Bank: TRÉSOR PUBLIC Grenoble 10071-38000-00003000056-07, mentioning DTIP2000-B0706
by VISAcard/Mastercard/Eurocard/American Express/Diners (SA UNIVAL) Total in Euro:

Credit Card N°:

Expiry Date:

Name of Cardholder:

Date: Signature:
on site: payment will only be accepted with VISAcard/Mastercard/Eurocard/American Express/Diners Credit Card payment in Euro or cash in FF.

The Symposium registration fee includes the welcome cocktail, the lunches on 9-10-11 May, the Parisian evening on 10 May, the coffee breaks and a copy of the Proceedings.
A cost of 110FF / 16,77Euro will be charged for accompanying persons for the welcome cocktail on 9 May and a cost of 600FF / 91,47Euro for the Parisian evening on 10 May. If you require, please indicate the number of accompanying persons and add the corresponding amount to the payment.

accompanying persons at the welcome cocktail
accompanying persons at the Parisian evening
tick here if you wish vegetarian meals

Refund policy for preregistration: there is a 200FF / 30,49Euro service charge for processing refunds. Requests for preregistration refunds must be received no later than 7 working days prior to the first day of the Symposium to be honoured. No refunds will be issued after 28 April 2000.
Substitutions will be accepted at any stage.

The form is to be returned:

DTIP2000 Symposium
TIMA
46, avenue Félix Viallet
38031 GRENOBLE cedex 1
FRANCE
Fax: +33 4 76 47 38 14

IEEE / SPIE No:	........................................................................................
Last or Family Name:	........................................................................................
First or Given Name:	........................................................................................
Organisation:	........................................................................................
Address:	........................................................................................
	........................................................................................
Country:	........................................................................................
Email:	........................................................................................