INSCRIPTION/REGISTRATION FORM

Nom/Name                                                         

Pr¨¦nom/Surname name                                         Sexe/Sex            

Titre/title                      Institution                                          

Adresse/Address                                                                  

Email                                    Fax                                    

l         Je participe au/I will attend the XXII ICHS du/from        au/to        juillet/July 2005.

l         Je paie avant le 15 mars 2005 et je verse la somme de US$185/I shall pay before 15 March 2005 and I am paying the amount of US$185 by       (A: Ch¨¨que/Bank Draft; B: Virement/Bank Transfer; or C: Carte de cr¨¦dit/Credit Card).

l         Je paie apr¨¨s le 15 mars 2005 et je verse la somme de US$215/I shall pay after 15 March 2005 and I will send the amount of US$215 by       (A: Ch¨¨que/Bank Draft; B:    Virement/Bank Transfer; or C: Carte de cr¨¦dit/Credit Card).

l         Je pr¨¦sente une communication et je renvoie le formulaire Form-B de r¨¦sum¨¦/I will give a paper and I am sending my paper abstract on the Form-B: oui/yes      non/no       .

l         Ma communication est souhait¨¦e de pr¨¦senter au Symposium/Section (num¨¦ro s¨¦riel                   )/My paper is under Symposium/Section                        

(for instance SC4, S4, or Section 9.1 )

l         Demande particuli¨¨re pour la restauration/Special dietary requirements: kascher/kosher   

  Musulmane/Muslim      v¨¦g¨¦tarienne/vegetarian      .

l         Je souhaite que le Congr¨¨s s¡¯occupe de ma r¨¦servation d¡¯hôtel et je renvoie le formulaire Form-C ci-joint/I wish the Congress to deal with my hotel reservation and I am sending the Form-C: oui/yes      non/no      .

Signature                          

Date