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Registration Form / Fiche d'Inscription

8th International Advanced Robotics Programme (IARP) Workshop (to return by e-mail or fax before / à retourner par mél avant le: April 24, 2010 )

Personal Information / Informations personnelles: Title / Grade (check one / cocher une case): Prof. [ ] Dr. [ ] M. [ ] First Name / Prénom: Last Name / Nom: Name for Badge / Nom sur la Badge: Affiliation: Department / Département: Address / Adresse: City / Ville: Phone / Tel:+( ZIP Code / Code postal: Fax: +( ) Country / Pays: Email:

May/Mai 10-12, 2010, SOUSSE, TUNISIA

HUDEM'2010

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@

Conference registration / Inscription à la Conférence (circle the relevant amount / cercler la somme correspondante)

Other/Autre 200 euros 400 TND Exhibitor/ 100 euros /day 200 TND Student/Etudiant Accompanying person/Accompagnant 50 uros 70 TND Full registration fees include welcoming and farewell receptions, coffee breaks, and one set of the conference proceedings on CDRom and Social program / Les frais d'inscription incluent l'accueil, les pauses cafés, les repas, le CDRom des communications de la conférence et la visite touristique. Hotel Reservation / Réservation de l'hôtel Date of arrival/Date d'arrivée Departure date/Date de départ Flight Number/Numéro du vol

Official IARP Delegates/Membre de la délégation officielle de l'IARP Author /Auteur 150

Participants

150 euros

Cost -

Coût -

300 TND

Social Program / Programme Social: (check / Cocher) · Trip to Kairouan and Eljem / Visite à Kairouan et Eljem (May 12) Total amount due / Somme Totale: . Method of Payment / Méthode de Payement: (bank transfer or credit card) · Bank Transfer with reference to / Par transfert bancaire

[

]

( Euros)

· You can charge the total amount to: (Check / Cocher) Cash (On-site) : [ ] Order Form / Bon de Commande : [ Other / Autre : (Specify / Spécifier) Signature: ]

Compte : ATM R.I.B National: 14 502 5021017004421 IBAN:TN59 1450 2502 1017 0044 2151 Code BIC: BHBKTNTT Agence BH : Monastir / 7 Novembre

Please, include HUDEM'2010 in the transference document and send a copy of the receipt to the Conference Secretariat by fax and/or email. THIS FORM SHOULD BE RETURNED TO: HUDEM'2010 secretariat (Brussels AND Sousse) Fax Brussels: 32-2-742 6547 AND Fax Sousse: 216-73-220 470 e-mail: [email protected] AND [email protected]

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