MECATRONICS-REM2016

Please type or write clearly in block letters and check boxes where appropriate and fax, post or email to:

Please provide information as you wish it to appear on your badge and in the list of participants (1).
"If these informations (First Name . Name . Company and Country) are not correct for establish the badge, please send an email."
Each participant should complete one copy of this registration form.
Please complete using a typewriter or block letters. Do not forget to make a copy for your own records.

( * ) Required field

Participant Information (1) ( use only alphabetic letters )

Title *: MrMrsDrProf

First Name *: Name *:

Nationality *: Position *:

Company/Organization *:

Address *:

Postal Code : City/State *:

Country *: E-mail *:

Phone (incl. country & city codes) : Fax (incl. country & city codes) :

Mobil Phone :

Billing Address

Same as above

Company/Organization *:

Address *:

Postal Code *: City/State *:

Country *: E-mail :

Phone (incl. country & city codes) : Fax (incl. country & city codes) :

Registration fees ( TTC )

* Tick category and fill in the amount to be paid.
* To qualify for the fees below, every registrant shall provide proof of status on the registration form.

early by June 1 2016 late after June 1 2016
Faculty or Presenting person*400 Euros500 Euros
Student200 Euros250 Euros
Industrial400 Euros500 Euros
Accompanying person (Gala dinner)150 Euros150 Euros
*Registration of one of the authors using FULL registration and associating the paper at the time of registration

Paper Id :

Faculty Student Industrial
Accompanying person

Registration fee includes : invited talks, lunches & coffee break, Gala dinner, Proceedings, social event.
From 15 to 17 June

Attendance to the meals :

lunch June 15,2016
lunch June 16,2016
lunch June 17,2016
Gala dinner 16, 2016


Vegetalian
Vegetarian

Due ( TTC ) : Euros

Payment options

Payment must be made in advance and are payable to: UTEAM.
Please make sure that you indicate "MECATRONICS-REM2016" and the participant's name on all payments.
Payment should be made in Euros.
Order forms has to be made to:

Credit card ( Only MasterCard, Visa and CB will be accepted. On-line registration is now opened )

Bank transfer
  Payable in Euros to the following account:
  Bank : Crédit du Nord Compiègne Entreprise
  Code banque : 30076
  Code Guichet : 02626
  Num de compte : 10337100201
  Clé Rib : 44
  IBAN : FR7630076026261033710020147
  BIC : NORDFRPP
  SIRET : 34230024100029

Check (only in Euros) to UTEAM

Cash on the site (only in Euros)

CANCELLATION

For any cancellation, contact as soon as possible UTEAM by e-mail, fax or letter.
For a cancellation after June 1st, 2016 : 70 Euros will be charged for the administrative costs.
After this date, no refund is possible
It is impossible to cancel a registration if your paper is accepted by the comittee

This information is intended for the organizers UTeam or REM2016 in the purpose of setting down the list of the participants.
You may oppose to the publication of your email address in the list of participants by ticking here
You have a right of access and modification by applying to UTeam until 14/06/2016.