test-FH

* : Required field

Title (*) MrMrsMsDrProf

Gender (*) FemaleMaleOtherI do not wish to answer this question

First Name (*)

Last Name (*)

Email (*)

Note: For CNRS researchers and in case submitting the form generates an error message, try with your @cnrs.fr adress (for example name@cnrs.fr instead of name@cnrs-orleans.fr, or name@ibl.cnrs.fr)

Phone number

Position(*) —Please choose an option—Master 2PhDPostDocEngineer or technician in industryAcademic engineer or technicianCommercial PartnerAcademic researcherResearcher in industryOrganizing committeeInvited speaker

If you are a PhD student, please indicate What year of your PhD program are you in : 1st Year2nd Year3rd Year4th & more

Institution(s) or Company (*)

Laboratory

Indicate the number of your laboratory (only for French UMR, UPR, U, etc)

ex: UMR7200, U62, etc

Address (*)

Postal Code (*)

Town (*)

Country (*)

Do you want to submit an abstract ? (*)
Yes, only Oral CommunicationYes, Oral Communication AND PosterYes, only PosterNo

Do you apply for a bursary ? (*)
YesNoNot applicable

Choose your accomodation (There is a limited number of single rooms) (*)
Single roomDouble room

Fees (*)
Student/Post-Doc - twin room - 390 €Academic - twin room - 590 €Academic - single room - 740 €Private company - twin room - 820 €Private company - single room - 970 €Private company - congress only - 660 €

Mode of payment ? (*)
Wire TransferPurchase Order (Bon de commande)No Registration Fee

Would you like your name and email to be included in the meeting list? (*)
YesNo

Do you consent to the use of your image for the GFPP24 comunication ? (*)
YesNo

Special diet or food allergy

Eventual comments

I confirm I have read and accepted the Terms and Conditions of Cancellation.

By clicking on “Submit” you will pre-register for the GFPP meeting. Your registration will be completed only after your payment (instructions will be sent by email)

Which number is smaller, 6 ou 2 ?

Svp prouvez que vous êtes un humain en sélectionnant La Voiture.

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