JFPLC'97 - Registration Form

To be sent or faxed to
  JFPLC'97 -- LIFO
  Faculte des Sciences
  Universite d'Orleans
  4, Rue Leonard de Vinci
  B.P. 6759
  45067 ORLEANS Cedex 2
  FRANCE

Fax:  +33 2 38 41 71 37


Mrs O     Mr O

Name: _____________________________ First name: _____________________________

Affiliation: ________________________________________________________________

Address: ____________________________________________________________________

         ____________________________________________________________________


Telephone: ________________________        Fax: _____________________________

E-mail: _____________________________________________________________________

I will participate in the excursion and banquet:    yes O     no O

Student (less than 26 years old):     yes O     no O
Join a student card or a certificate signed by the thesis advisor or
department head.

Conference fees before April 25, 1997
                                                  ALP/AFPL
Student (less than 26 years old)      800 FF O     700 FF O
Universities                         1400 FF O    1200 FF O
Other                                1700 FF O    1500 FF O

Conference fees after April 25, 1997
                                                  ALP/AFPL
Student (less than 26 years old)     1000 FF O     900 FF O
Universities                         1600 FF O    1400 FF O
Other                                1900 FF O    1700 FF O

The ALP/AFPL fee is reserved to members of one of these associations.
Participants to JFPLC'96 must renew there subscription to ALP/AFPL.

Number of accompanying persons: ____ x 300 FF
(excursion and banquet registration)

Registration to the industrial sessions only:     150 FF O




O Payement by credit card to DUNOIS Voyages (licence No 128003)

  Visa O     Mastercard O     American Express O

Amount: ________________________ FF

Card number: _____________________________________     Expiry date: ___ / ___

I the undersigned, (name first name, please use capital letters)

___________________________________________________________________________ ,
abide by the clauses of sale as defined by the Law No 92.645 of the 13th of
July 1992 and Decree No 94.490 of the 15th of June 1994.

Date: __________________________     Signature: