Registration Form


DEADLINE FOR REGISTRATION

Rencontres de Blois 2018: 

April 30th, 2018


* fields are mandatory

Gender: * 
Family Name: * 
First Name: * 
E-mail: *
Date of birth: 
Professional Status: 
Are you: 
Field of interest
Collaboration: 


1. Home Institution

Name: *
Street/Bldg: *
City: *
Postal code: *
Country: *
Your Phone: 
Portable Phone: 


2. Address for proceedings shipping
(if different from above)

Street/PObox/etc: 
City: 
Postal code: 
Country: 


3. Accompanying Person(s)

Will you be accompanied : 

by your spouse/partner?
Name and First Name: 
by your children?
First Name:  Age: 
First Name:  Age: 
First Name:  Age: 


4. Arrival / Departure

by train/car ?
Arrival Date: * 
Approx. Time: 
Departure Date: * 
Approx. Time: 


5. Special Needs

Vegan meals required ?
Vegetarian meals required ?
(fish accepted)


6. Hotel Reservation

Do you need the secretariat
to take care of your hotel reservation
If Yes 
Type of room : 
Type of hotel : 


7. Remarks