REGISTRATION FEES

PRINT and RETURN This reply to the Congress Secretariat by mail or fax: 33 (0) 1 47 66 74 70

	Before	After	On site
	15 November 1999
Active Participants	3 000 FF	3 500 FF	3 700 FF
Members of Eurogin	2 800 FF	3 000 FF	3 200 FF
Students and residents under age 30 with ID	2 200 FF	2 400 FF	2 500 FF

Payment should be made in French francs by :

Bank check payable to :
EUROGIN 4th International Congress

Bank transfer to :
Société Générale, BP 105 Bd Jean Jaurès, 92100 Boulogne Billancourt France, France
account n° EUROGIN 00050638522 Key 17
(please add 100 FF for exchange bank charge)

Credit card (Visa only)
Credit card number :

I__I__I__I__I__I__I__I__I__I__I__I__I__I__I__I__I

Cardholder's name : .............................................................
Expiry date : ........................................................................
Date : ..................................................................................
Signature. :

Name : ........................................................................................................................................ Speciality : ................................................................................................................................. Address : ..................................................................................................................................... Zip code : ........................................ City : ................................................................................. Country : ................................................................................ Tel : ...................................................... Fax : ...... .....................................................................

PLEASE REMEMBER TO RETURN THE REGISTRATION COUPON WITH YOUR PAYMENT TO : EUROGIN 2000 BP 790 - 75827 PARIS CEDEX 17 - FRANCE