IFM 2014

Registration form

Total amount to pay: {{montantTotal() && (montantTotal() | amount) || '-----'}}

Please make out your cheque in euros and payable in France to: Alpha Visa Congrès / {{congresNom}}
Send it to:

Alpha Visa Congrès / {{congresNom}}
624 rue des Grèzes
34070 Montpellier
France

When making your bank transfer, please indicate the reference: "{{congresNom}} {{data.prenom}} {{data.nom}}".

IBAN code: FR76 1350 6100 0062 1508 6300 032 - BIC code: AGRIFRPP835

Please indicate the reference: "{{congresNom}} {{data.prenom}} {{data.nom}}" on the purchase order
and send it:

by email to {{congresEmail}},
or by fax to +33 (0)4 67 45 57 97,
or by regular mail to:
Alpha Visa Congrès / {{congresNom}}
624 rue des Grèzes
34070 Montpellier

Invoice address*

To the above-mentionned address To a different address

Company / Institution*

Department

Address*

Post code*

City*

Country

Intracommunity VAT number

(Your company’s intracommunity VAT number)

Registration form