32st E.W.C.B.R. /Registration and accommodation form
To be faxed to 33.1.49.69.96.57. or sent by e.mail to ewcbr@asso.univ-paris5.fr as soon as possible:
E.W.C.B.R., 34 rue Victor Carmignac -94110 ARCUEIL - FR
Name:
First Name:
Adress 1:
Adress 2:
Adress 3:
City:
Country:
Telephone:
Fax:
E-mail:
A) MEMBERSHIP DUES
- Payment from Institutions or Universities
€ 190 (euros)
After November 30, 2012
€ 220 (euros)
-
Payment
Junior Scientist from Institutions or Universities
€ 50 (euros)
- Others (pharmaceutical companies...)
€ 350 (euros)
After November 30, 2012
€ 400 (euros)
- Accompanying members
€ 30 (euros)
Total A:
€
B) ACCOMMODATION:
• I wish to have a private room
• I wish to share a double room with another participant
• I wish to share a double room with :
HOTEL
Eurotel Victoria Villars sur Ollons ( Switzerland)
:
as indicated, for 7 nights from Saturday March 10th at dinner to Saturday March 17th at breakfast (
HALF PENSION (breakfast and dinner) ski-pass NOT included
)
SINGLE ROOM :
945 €(euros)
after November 30 :
980 €(euros)
(Attention : the number of single rooms is limited, please register rapidly if you are interested)
DOUBLE ROOM (per person) :
735 €(euros)
after November 30 :
770 €(euros)
Children :
if sharing their
2
parents' rooms.
0-9 years old : free 9-13 y. old : 525 €
Total B:
€
C) SKI-PASS 6 DAYS:
ADULT : 215 €.
ADULT +65 & CHILD (5-12 Years old) : €.
Total C:
€
Total A + B + C:
€
• PAYMENT BY CHECK :
(French participants and from Euro Zone countries) made out to
PROMOTION DES NEUROSCIENCES EUROPEENNES
• PAYMENT BY BANK TRANSFER (others) :
following bank account :
B.N.P. (BANQUE NATIONALE DE PARIS) St Andre des Arts, 3 Place St André des Arts, 75006 PARIS. Account no. 30004-01841-05317896-83. (EUROCHECKS WILL NOT BE ACCEPTED).
All bank info for bank transfer on web site
Please use a keyboard (or if by hand block letters) to complete this order form and return it together with a copy of your bank transfer to the above address.
VERY IMPORTANT: MAKE SURE YOUR NAME APPEARS ON THE BANK TRANSFER
If I cancel my booking, I allow
PROMOTION DES NEUROSCIENCES EUROPEENNES
to keep the following amounts as cancellation fees :
•
Cancellation up to 8 weeks before departure ; 50 % of the total amount
•
less than 8 weeks before arrival or in case of no show : 100 % of the total amount
DATE (yyyy/mm/dd):
SIGNATURE:
Even though you reserve through our website, please confirm by email or fax for more safety!
controle anti-spam: