CONFERENCE REGISTRATION FORM

IXth International Symposium on Luminescence Spectrometry
Montpellier, the Corum, Convention Center
15 - 17 May 2000

Surname : First name :

Title : Affiliation :

Address :

Town/City : Postal code: Country :

Phone : Fax :

E-mail address :

Contributed paper (poster, oral)	YES NO
Please send information for exhibitors	YES NO

Full registration:	2 000 FRF (before January 10, 2000)
	2 300 FRF (after January 10, 2000)
Student registration:	1 000 FRF (before January 10, 2000)
	1 200 FRF (after January 10, 2000) (Confirmation of status by supervisor required)
Outing in Camargue with dinner :	250 FRF (per person) / Number of persons:
Amount for outing :	FRF
Total amount transferred :	FRF

By bank transfer By Check
Bank transfers, in FRF only, should be directed free of bank charges to :
AGENT COMPTABLE ENSCM / LUMINESCENCE
Account number : 10071/34000/00003003560/25

Date : …………………………… Signature : ………………………………………

Please print this form and send it.