Registration form

DX'97

Eighth International Workshop

on Principles of Diagnosis

Le Mont-Saint-Michel, France

September 15-18, 1997

REGISTRATION FORM

To be returned as soon as possible to the following address:

Elisabeth LEBRET
IRISA/INRIA
Campus universitaire de Beaulieu
35042 Rennes Cedex, France

Fax : 33 2 99 84 71 71
email: lebret@irisa.fr

PERSONAL INFORMATION :

Ms.

Mr.

LAST NAME: .................................................. First name: .....................................

Affiliation/Institution: ............................................................................................
Address: ................................................................................................................
........................................................................................................................................
Zip code .......................... Town ............................... Country ..............................
Phone .............................. Fax ................................. Email ...................................

REGISTRATION FEE (20,6 % VAT included):

Before August 15

After August 15

Participant

2300 FF

2600 FF

The fee includes attendance at the workshop, proceedings, coffee breaks, meals, and reception on September 14.
The registration fee does not include the hotel accommodations.
Your room reservation will be made by the secretariat of the workshop but accommodation
charges will be billed to you directly by the hotel.

PAYMENT:

This registration is made

on a personal basis

on an official basis

Please find enclosed a purchase order from my company.

Please find enclosed a cheque of |_|_|_|_| FF

Cheques should be made payable to the Agent comptable de l'INRIA in French currency.

I am sending a bank transfer (in french currency)

Trésorerie Générale des Yvelines, 16 avenue de Saint- Cloud, 78018 Versailles, France.
(bank code: 10071; branch code: 78000; account number: 00003003958; key: 80)

We regret the registration fee cannot be paid by credit card.

Please do not forget to state your name and the Workshop reference: DX'97

Registrations without payment or purchase order will not be considered.

CANCELLATION

The fee will be returned in full for any written cancellation before September 1, 1997. No refund will be
made for cancellation received after this date.

ACCOMMODATION:

Important: After August 15, hotel reservations will be on space-available basis only.

Prices indicated below are per person and per night, breakfast included:

Type of Room	Price
Single	300 FF
Twin/Double	200 FF

I reserve:

A single room

A twin room

A double room

from ..................................... to ................................. i.e. .................................... night(s)

Roommate request: ............................................................................................

N.B.: if you choose a twin without mentioning a roomate, one will be automatically assigned.

Your room reservation will be made according to your request but accommodation
charges will be billed to you directly by the hotel. Credit cards are accepted.

TRANSPORTATION BETWEEN RENNES AND LE MONT-SAINT-MICHEL

I will use the special bus to Mont-Saint-Michel on Sunday (departure from Rennes
railway station at 6:45 p.m.)

Yes

I will use the special bus to Rennes on Thursday (departure to Rennes at 2:00 p.m.)

Yes

SPECIAL REQUIREMENTS OR DIETARY RESTRICTIONS

..............................................................................................................................................................

Date: Signature: