2nd Service Reserch Publishing Workshop (May 30 and 31st, 2016)
REGISTRATION FORM: (due by March 30, 2016)
Conference Package*:
· Participant rate with copy editing :800 € Euros
· Participant rate without copy editing:585 € Euros
*The conference package covers participation in the conference, proceedings, lunch, dinner, and a guided tour of Aix-en-Provence.
All fees are to be paid in full by March 30, 2016, by Visa or Master Card, bank transfer, check or “bon de commande universitaire”.
Participant Information:
Mr./Mrs./Miss (LAST NAME)……………………………………………. (First NAME) ………………………………………………………
email: ………………………………………………………………………. @......
s Visa or Master Card (no AMEX/DINERS)
Please charge my Visa/Master Card (circle one) a total of……………………………………………………………………………….Euros
**Indicate all 16 numbers
n° / expires : / /Date ……………………………………….. Signature ……………………………………………………. 3-digit security code:
Sending option for card information: You can communicate your card information in separate emails for security purposes.
s Bank transfer (must include transfer statement)
“L’AGENT COMPTABLE AMU - 932”
TRESOR PUBLIC Sort Code 10071 Branch Code 13000 Account N° 00001020067
Domiciliation TP MARSEILLE IBAN FR76 1007 1130 0000 0010 2006 780 - BIC TRPUFRP1
(An original of this document is available: to obtain it, please contact Jeanette Theokritoff by email)
*All bank charges are to be paid by the participant
Important: Transfer statement required in order to confirm registration (please send this document by email)
s Check
Enclosed check in the amount of …………………………………………….………………..€, made payable to:
“L’AGENT COMPTABLE AMU - 932”
Please mail this check to Laurence Nicolas – Accounts Dept. IAE Aix (address below)
s “Bon de commande universitaire”
For French Universities only, the «Bon de Commande Universitaire» should be mailed to:
IAE Aix-Marseille – Aix-Marseille Université
(Attn: Laurence NICOLAS – Comptabilité – 932)
Chemin de la Quille – CS 30063 - 13089 AIX EN PROVENCE CEDEX 02
Or fax at 04 42 28 08 00
** Please email this form to **