IPM 2016

Contact details for correspondence and list of participants

Civility*

Mr Ms

First name*

(Ex. Charles)

Last name*

(Ex. Darwin)

Position

Company / Institute*

Department

Address*

Post code*

Town*

Country*

Office phone*

Mobile phone

(will not appear in the list of participants)

E-mail*

Transportation

I will travel by

Plane Train Car

You can benefit from the special congress rate (35% to 60% of the Air France rate depending on availability) if you book via the following link:
www.airfranceklm-globalmeetings.com/?eid=27265AF

Payment

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Payment by *

Credit card (secured payment) Bank cheque Bank tranfer Purchase order (allowed only for French institutions)

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
FRANCE

Invoice address*

To the above-mentionned address To a different address

Invoice address

Company / Institution*

Department

Address*

Post code*

City*

Country*

Intracommunity VAT number

(Your company’s intracommunity VAT number)

Comments

I have read and fully accept the payment & cancellation conditions.*

* Required fields

You have a right of access and rectification to your personal data by contacting: Alpha Visa Congrès / {{congresNom}} - 624 rue des Grèzes, 34070 Montpellier - France - {{congresEmail}}

Thank you for registering.

Your reservation number: {{id}}.

An automatic confirmation has been sent by email.

Best regards

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Start over

Registration closed.

Online registration

Registration for IPM workshops

Registration for the Conference

Conference in English and French

Optionnal registration to the conference dinner

Sponsor

Intervenant invité

Publication

Invitation

Invoice address