Fiche inscription ASRDLF 2019/ Registration form for the ASRDLF 2019
Email address *
1. Prénom / First Name :
2. Nom / Last Name :
3. Email :
4. Confirmation/ Verify Email :
5. Organisation - Affiliation / Organization – Affiliation :
6. Département (Laboratoire de recherche) / Department (Research laboratory) :
7. Position (académique) / (Academic) Position :
8. Domaine de spécialisation / Main Specialisation :
9. Adresse / Address :
10. Zip/Postcode :
11. Ville / City :
12. Pays / Country :
13. Choix du tarif / Choice of tariff :
14. Dîner de gala / Gala dinner (35 euro):
Clear selection
15. Facture / Invoice :
Clear selection
16. Nombre personnes accompagnant diner de Gala / Number of people accompanying Gala dinner (35 euro)
Clear selection
17. Excursion dans le nord de la Moldavie / Excursion to northern Moldova (35 euro)
Clear selection
18. Nombre personnes accompagnant - Excursion dans le nord de la Moldavie / Number of accompanying persons - Excursion in northern Moldova (35 euro par personne)
Clear selection
A copy of your responses will be emailed to the address you provided.
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