e-Colloque - Registration

Welcome to SRDS 2019

Lyon, France, October 1-4, 2019

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Step 1 / 4 : Registration

EARLY REGISTRATION UNTIL AUGUST 31^TH, 2019

*Gender :**	Mr Mrs
*Family name :**
*First name :**
*Affiliation / Company :**
*Address :**
Address :
Postal Code :
*City :**
*Country :**
Phone number :
*E-Mail :**
Confirmation of e-mail :

Step 2/4 : Your choice

Welcome

Registration type
Full (Workshops + Conference) - IEEE member	1	500.00 €
Full (Workshops + Conference) - Non-IEEE member	1	600.00 €
Full (Workshops + Conference) - Student	1	350.00 €
Workshops only (including Women in Computing Systems & Engineering)	1	120.00 €
Women in Computing Systems & Engineering only	1	60.00 €
Women in Computing Systems & Engineering only-Free for undergraduate female student (limited number)	1	0.00 €
For students, please indicate University and student number
IEEE membership number
Extra ticket for conference reception
Extra ticket for conference reception	1	95.00 €
Extra ticket for conference Banquet
Extra ticket for conference Banquet	1	120.00 €

Step 3/4 : Validation

Your address

Billing address

Name :
First name :
Company :
Address :
Adress :
Postal Code :
City :
Country :
Tel :
Billing Mail :

Your order

Amount of your order :

Payment means * :
Credit card

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Bank Transfer

Payment to : INSAVALOR S.A.
66 bd Niels Bohr
CS 52132
69603 Villeurbanne cédex
France
Swift Code : CCBPFRPPLYO
IBAN : FR76 1680 7004 0000 2319 3868 296

Bank Name and Address :
Banque Populaire Loire et Lyonnais
Centre d’Affaires Lyon Villeurbanne
359 Cours Emile Zola - 69100 Villeurbanne
France

Order form

Please send the order form as soon as possible at contactcolloque@insavalor.fr

© INSAVALOR 2019

Conception / Réalisation / Hébergement : ADVI SARL