Development and Modulation of Mucosal Immunity

1
Development and Modulation of Mucosal Immunity
Registration form
Participant Last name, first name
_____________ Name and address of institution
_________________________________ Phone
Number ________________________ Fax Number
________________________ Email _______________

• Fees (before April 13th 2007 , only 100
  participants will be accepted)
• Registration
• INRA participants 80
• Non-INRA participants (VAT 19,6 included)
  100
• The registration fee includes admission to all
  scientific sessions, coffee breaks, Saturday
  lunch and bus transport Tours-INRA. Any claim of
  refunding will not be accepted after April 13th,
  2007.
• Presence at the dinner on May 4th
• Participant 25

Type of payment - Cheque ?
to Agent Comptable INRA,
Tours-Nouzilly - International bank
transfer ? IBAN FR76 1007 1370 0000 0010
0012 912 Bank Identifier Code BDFEFRPP -
Bank transfer (in France) ? 10071 37000
00001000129 12 TP Tours - Purchase order
n__________________ ? SIREN 180070039
Code APE/NAF 731Z Code TVA FR 57180070039
Participants are requested to complete the
enclosed registration form and to send it to the
organizing secretariat by e-mail
contactDMMI_at_tours.inra.fr (SAVE this file as
name.dmmi.registration. ppt) AND by fax at 33
(0)2 47 42 77 79.
Date
Signature