FAC - Attendee registration

Attendee registration

Please fill in the form below before April 3rd, 2010 :

This form is a pre-registration and must be completed before payment. You can be pre-registered and pay later (the applicable rates are according the pre-registration date).

I am already pre-registered and I would like to pay : click here

ATTENDEE PRE-REGISTRATION FORM

ATTENDEE INFORMATION

Title	:
Last Name *	:
First Name *	:
Profession *	:
Company Name *	:
Address *	:
Country *	:
Your email *	:
Phone *	:
Mobile	:
Fax	:
Requirements (dietary, special access...)	:
_____________________________________________________________________________
YOUR REGISTRATION TO FAC2010 *	:	Tuesday 4th May 2010 (200 € ) Wednesday 5th May 2010 (200 € ) Thursday 6th May 2010 (200 € ) Friday 7th May 2010 (150 € ) Full Access - May 4-7th 2010 (450 € *)
* Early bird rate (before April 3rd 2010). See the registration fees details.
_____________________________________________________________________________
PAYMENT INFORMATION
Payment mode	:
Invoice address (if different from your office address)	:
Intra-community VAT number (EU countries)	:
SIRET number (only France)	:
_____________________________________________________________________________
* : Obligatory field