REGISTRATION FORM TO BE FAXED OR SENT TO:
INTERNATIONAL SCHOOL ON REWRITING 2006

Anne-Lise CHARBONNIER
INRIA Lorraine
615 rue du Jardin Botanique
54 600 Villers-lès-Nancy  – France

Fax: 03 83 27 56 52 -  International: +33 3.83.27.56.52
E-mail: Anne-Lise.Charbonnier@loria.fr

Registration deadline: Your registration form and payment must be received by Friday, June 23rd, 2006.

Please type or print clearly
Name 
Last name (family name): ______________________________ First name: ___________________________ 
Title: (Prof., Dr., other) _______________________________
E-mail: _______________________________________________________________________________
Sex:  Male   Female
Citizenship: ________________________
Affiliation: ____________________________________________________________________________
Street & number: _______________________________________________________________________
City: ___________________________ State: __________________________ Zip code: ______________
Country: ______________________ Phone (including area/country code):_____________________________
Fax (including area/country code): _______________________________
Vegetarian Food:   yes    no
Registration Fees include: Summer School attendance, a copy of courses slides, breakfasts, lunches, coffee breaks, social events, and student party.  (VAT 19,6% included)
Summer School registration 	Student*	Normal	
Registration without lodging until May, 31	__ x  200 €	__ x  400 €	
Registration with lodging until May, 31 **	__ x  300 €	__ x  500 €	
Registration without lodging from June, 1	__ x  300 €	__ x  500 €	
Registration with lodging from June, 1 **	__ x  400 €	__ x  600 €	
Social Events + student party for accompanying person	__ x    40 €	__ x    40 €	
Total:	________  €	
*   Please, join a copy of your student card
** Lodging in University Residence from Sunday, July 2nd to Friday, July 7th (only 30 rooms available)

Payment (select one option)

q Please charge my credit card
Card type:	q Visa     q Master card
Credit card number: _______________________________ Expiry date (month/year): _____/_____
Security code (last 3 digits printed on the back of your card): __________
Amount: _____________ €
Card holder name: ___________________________________________________________
Card holder signature:

	

q  Please find enclosed a Bank Check of …………………………………Euros (no personal checks accepted)
Make checks (in Euros only) payable to “Agent Comptable de l’INRIA”

q Bank transfer:
A copy of the bank transfer should be enclosed with the registration form. Please quote ISR’2006 as reference.

Name of the Bank: Trésorerie Générale des Yvelines
Beneficiary: Agent comptable de l’INRIA
Address: 16, avenue de Saint Cloud  –  78018 Versailles  –  France
Account number: 00001003958 – RIBKey : 48
Bank code: 10071  –  Agency: 78000
Swift code: BDFEFRPPXXX   -   IBAN FR 76 1007 1780 0000 0010 0395 848 

q Bon de Commande (For French Academic only) to INRIA Lorraine.

Date: ______________________Signature: ________________________________

Note:
To register, please FAX a copy of the filled form to the number and name indicated on the top (payment must still be received by Friday June, 23rd 2006; early registration deadline is May, 31st 2006).