Pre-Registration Form on-line at CASYS'11

CHAOS asbl, Dr. Ir. Daniel M. DUBOIS, Institut de Mathématique, B37, Université de Liège, Grande Traverse 12, B-4000 LIEGE 1, Belgium. Fax: +32 (0)4 3669489 E-mail: Daniel.Dubois@ulg.ac.be

Fill the fields and click on SUBMIT to send your pre-registration form by email,

or print this form and send it by post mail or fax.

Please put my name on your mailing list

I plan to attend CASYS'11 as a participant

I intend to present a paper at CASYS'11

Tentative Title of my paper and name(s) of author(s) are written in the next text area :

Fill the fields (the fields REALNAME and EMAIL must be filled) :

REALNAME (First, Middle, Last names):
EMAIL:
Date of Birth:
Title/Position:
Institution:
Department:
Street, nr:
Town:
Country:
Tel (Office):
Tel (Home):
Fax:
Web:

Date Signature

Click on SUBMIT to send your pre-registration form by email,

then the message in French appears: "Le formulaire a été envoyé." ("The form has been sent.")