HRM, SME & Entrepreneurship Conference Exchanging Viewpoints MONTPELLIER, FRANCE AES - ESPACE RICHTER Thursday April 1st, 2010 http://www.ecsb.univ-montp1.fr

REGISTRATION FORM Mrs

Miss

Mr

PhD student

First name : ........................................................ Surname : ........................................................... Academic

Professional

Institution : ......................................................................................................................................................................................... Professional Address : ....................................................................................................................................................................... Postal code :......................................................................... City :................................................................................................... State / Province : .................................................................. Country : ........................................................................................... Phone : ................................................................................. Fax : ................................................................................................. E-mail : .............................................................................................................................................................................................. Billing Address (if different from the professional address) : ............................................................................................................ ............................................................................................................................................................................................................ Postal code :......................................... City :.............................................................. Country : ...................................................... Subscription charge (1) Academic

80 €

PhD student

40 € (2)

Professional

150 €

(1) Subscription charges for this one-day conference include conference proceedings, coffee breaks, lunch. Charges for accommodation and transport are not included. (2) Important : we thank you to join the photocopy of your student card.

Date : ................................................................................

Signature : ...........................................................................

Payment mode (has to be attached to the subscription form) : Bank transfer University order form For any payment with bank transfer, we thank you to precise the number of the bill on the transfer order. Bank transfer to the account of : Agent Comptable TP Montpellier Bank code 10071

Guichet code 34000

Account number 00001003383

RIB key 39

IBAN FR76

1007

1340

0000

0010

0338

BIC : BDFEFRPPXXX To be sent with the payment to : Université Montpellier 1 UFR AES Mme Magali Farenc Espace Richter - Avenue Raymond DUGRAND CS 59640 34960 MONTPELLIER Cedex 2 FRANCE Phone : 0033 4 67 15 85 56 – Fax : 0033 4 67 15 83 38 Email : [email protected]

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