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