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
All persons attending the conference are required to register and pay the appropriate fees.
Fill the following form and click on submit, or print this form and send it by post mail or fax.
I register as a : participant / author of a paper / author of an invited paper.
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:
Fill the following appropriate fields for Registration, Banquet, and Proceedings Fees :
Registration fee includes attendance to all CASYS'11 sessions and symposia, attendance at the official reception, and a bag with coffee-break tickets, a badge, the final program timetable and the conference abstracts book available at the conference.
Accompanying persons can attend the official reception, and register to the banquet.
Registration fee for CASYS'11 Conference
220.00 €
200.00 €, if paid before July 15, 2011
175.00 €, for member* of ASBL CHAOS
Registration fee for the BANQUET (indicate the number of persons)
40.00 € x persons
25.00 € x persons, for member* of ASBL CHAOS
Order fee for CASYS'11 Proceedings**
180.00 €, if paid before July 15, 2011
180.00 €, for member* of CHAOS
25.00 €, fee for 2011 membership of ASBL CHAOS
TOTAL FEE
€
* The discount is only available for the members of ASBL CHAOS having paid ALL THEIR ANNUAL FEES, since their first membership. Each new member of ASBL CHAOS engages to pay an annual fee of 25 euros.
** The proceedings will be published after the conference, in 2012.
Please send me an invoice - Address of invoice :
I pay the CASYS'11 fee by cheque.
I transfer the CASYS'11 fee by Bank to
BANK ACCOUNT OF CHAOS : IBAN BE50 3400 6169 9718, BIC-code ING Belgium (ING Swift address) : BBRUBEBB, Banque ING (International Nederland Group) (Avenue du Centenaire 1, B-4053 Embourg, Belgium - Tel + 32 4 361 66 30 - Fax + 32 4 361 66 38).
I transfer the CASYS'11 fee by Post to
POST ACCOUNT OF CHAOS : IBAN BE22 0001 1095 3347, BIC-code POSTCHEQUE Belgium : BPOTBEB1, POSTCHEQUE, Embourg, Belgium.
I pay the CASYS'11 fee by CREDIT CARD (a form is available on the web).
INSURANCE : The conference organisers can accept no liability for personal injuries, or for loss or damage to property belonging to conference participants, either during or as a result of the conference. Please check the validity of your personal insurance.
Date Signature
Click finally on SUBMIT, then the message in French appears: "Le formulaire a été envoyé." ("The form has been sent.")