Registration form 2021

Last Name
First Name
Laboratory
Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Invoice address if different of the laboratory adress :
Phone
Your gender
Email
exemple@exemple.com
To check*

I confirm my attendance to the workshop (22nd to 25th Septembre 2021)I am a student or a post-doc applying for an oral communication (*)I am a regular academical attendee, I will pay 450 € for registration feesI am a regular industrial attendee, I will pay 600 € for registration fees
I submit my abstract

Cancelof
I am a regular attendee, I will present a poster:

yesno
I will take the bus:

yesno
If yes, please indicate for your arrival on Sept. 22nd

Nantes railway station (15:30)Nantes airport (16:00)Vannes railway station (17:35)
If yes, please indicate for your departure on Sept. 25th

Vannes railway station (13:35)Nantes airport (15:15)Nantes railway station (15:45)
(*) Free registration and travel grant will be awarded to selected oral communication. I understand that if my abstract is not selected, I will have to register as a regular attendee. In this case, I can register until June 30th.

Register form must be send as soon as possible at : francoise.leost@univ-nantes.fr For information of the workshop: www.cgo-workshop-vecto.fr
Should be Empty: