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Diapositive 1

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Title: Diapositive 1 Author: GH Last modified by: Yann PENET Created Date: 12/9/2005 11:46:32 AM Document presentation format: Format A4 (210 x 297 mm) – PowerPoint PPT presentation

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Title: Diapositive 1


1
Registration Form
Formulaire Inscription
Last Name First Name Address Email Fax Phone
Nom Prénom Adresse Email Fax Tel

Fees DVD Included Before Sept. 24th After Sept. 24th
Surgeon 190 240
Fellow 130 170
Resident/DESCQ With Certificate 30 50
Physiotherapist 130 170
Tarif DVD Inclus Avant 24 Sept. Après 24 Sept.
Chirurgien/Médecin 190 240
Chef de Clinique 130 170
Interne / DESCQ Avec Certificat 30 50
Kinésithérapeute 130 170
Congress Dinner Add 90 x number of attendees
Dîner Congrès Ajouter 90 x nombre personnes
Total
Total
Send Check (order EZUS) or Bank Transfer
to Catherine PRUVOT, EZUS LYON 1 LATRIUM BP
2107 69616 VILLEURBANNE Cedex
FRANCE catherine.pruvot_at_ezus.univ-lyon1.fr
Envoyer Chèque (ordre EZUS) à Catherine PRUVOT,
EZUS LYON 1 LATRIUM BP 2107 69616
VILLEURBANNE Cedex FRANCE catherine.pruvot_at_ezus.
univ-lyon1.fr
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