Réseau LARC - Neurosciences
 
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Registration



/!\    The deadline for Registration    /!\
is October 6th, 2017
Participant
Title: *
Family name: *
First name(s): *
Position: * MSc Student PhD Student Post-Doc Student
Permanent (non-student), please specify:
Institution: *
Postal address: *

Zip Code: * City: * Country: *
Tel: Fax:
e-mail: *
Confirm e-mail: *


I want to register to the electronic version of the LARC-Neuroscience Letter


All payments must be in Euro and payable to INSERM
Registration fees are 30€ for regular participants and 20€ for students and post-docs.

Registration will be confirmed when INSERM has received your payment. Payment must be remitted as follows:


You will be redirected on the payment page after you confirm your registration below. The payment form is only available in French for the moment but all the information will be prefilled, you have just to tick the agreement "J'accepte les conditions d'utilisation" and click on "Valider" to be directed on the credit card information page.
Please indicate "LIL + LARC2017 + your name" on congress name field.
Please note that the two fields "Numéro SIRET organisme" & "Numéro de TVA intracom" are to be filled only by participants from french companies, please write "XXXXX" if you are not in this case.

For example :

Intitulé colloque/formation (Congress name) : LIL + LARC2017 + your name
Date (dd/mm/yyyy) :
Numéro SIRET organisme (Only for french society) : XXXXX
Numéro de TVA intracom (Only for french society) : XXXXX
Nom de l'organisme (Institution) : INSERM
Nom (Last Name) :
Prénom (First Name) :
E-mail :
E-mail (Confirmation) :
Adresse (Postal Address) :
Code postale (Zip code) :
Ville (City) :
Montant à régler (Registration Fee) :
J'accepte les conditions d'utilisation : Tick to accept the conditions of Use

Click on " Valider " (Confirm) button

For the next step, you can click on the US flag to switch the form in English.






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If you have any problems, please contact:
Jerome Clasadonte (jerome.clasadonte@inserm.fr),

Inserm U1172 - Jean-Pierre Aubert Research Center
Bâtiment Biserte
1 place de Verdun
59045 Lille cedex
France

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