Registration Form

Please complete the registration form below and send it (by e-mail, fax or ordinary mail) to :

Mrs. Cathy Berjaud - Scientific Secretariat IRAM 
300, Rue de la Piscine
F-38406 Saint Martin d'Hères, France

Fax :  +33 476 51 59 38

Email:  berjaud-at-iram.fr (please specify "IRAM School 2006" in the subject field)


Deadine for applying to financial support is June 15th 2006
Deadline for inscription to the school is September 1st 2006
 


Name


Name :  

Institute : 

e-mail :

Phone : 

Fax: 

School registration

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 I want to attend the school and register now.  I took note of the cancellation policy (see the Registration & Funding information page).
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 I would like to present a poster (please enclose an abstract, not more than 10 lines).
Title :
Author(s) :
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 I would like to apply for EU financial support (please enclose a CV). I noticed the funding policy (see the Registration & Funding information page).

Hotel room reservation : October 1st  (arrival) to October 7 (departure)
$\bullet$ I will make my own appointment.
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 Please reserve me a single room (rates as indicated on the school's web page).
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 Please reserve me a shared double room (rates as indicated on the school's web page).
My gender :  $\bullet$   Female   $\bullet$  Male .
I am smoker $\bullet$    non-smoker  $\bullet$ .
$\bullet$ I would like to have breakfast at the hotel (rate as indicated on the school's web page).

For an extension of your stay, please contact the hotel directly