Registration Form

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REGISTRATION FORM

[] Mr   [] Mrs  [] Miss

LAST NAME: ...........................First Name:..............................

Organization: .................................................................

Address: ......................................................................

...............................................................................

Town: .........................................................................

Zip Code: ......................Country: ......................................

Tel: ...........................Fax: ..........................................

E-mail: .......................................................................

will participate to the Eurographics Workshop on Parallel Graphics and
Visualisation.


PAYMENT
~~~~~~~

In all cases below, prices are given in French Francs (FRF), 20,6 % VAT included

Conference fee, choose between :               
     Member of EUROGRAPHICS(*):                []  ( 870 FRF)
OR   Non-member of EUROGRAPHICS:               []  (1500 FRF)

  (*)EUROGRAPHICS membership number: _____

These fees include the access to the meeting room, 2 lunches, the
dinner on September 24th and coffee breaks. My payment (in French currency)
will be made :

[] by cheque to "Agent comptable de l'INRIA" and sent by post
[] by bank transfer:    
   Trésorerie Générale des Yvelines, Versailles:
   (10071: bank code ; 78000: branch code ; 00003003958 : account number ; 
    80: key)

[] by credit card: 
   For this means of payment, the original signature is mandatory.

   Cardholder name and first name: .............................................

   Card number: |_|_|_|_| |_|_|_|_| |_|_|_|_| |_|_|_|_| Expiry date: |_|_| |_|_|
   
   I hereby authorize INRIA to charge my credit card: 
   [] Visa     [] Mastercard     [] Eurocard

                                                    Cardholder signature
                                                   ______________________
                                                  |                      |
                                                  |                      |
                                                  |______________________|

   

Please write your name clearly and make reference to the Eurographics
workshop on Parallel Graphics and Visualisation on your payment.
Registration without payment will not be considered.


Cancellation
~~~~~~~~~~~~

Fees will be returned in full for any written cancellation before 
September 14, 1998. No refund will be made in respect of cancellation
received after this date.


Dietary restrictions
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DATE: ......................................                     

SIGNATURE: ................


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