Family name:
Citizenship: Sex M [ ] F [ ]
Affiliation:
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Address for correspondence (if different from above):
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Tel : ............................... Fax: .............................
E-mail: ................................................................
Vegetarian No [ ] Yes [ ]
Accompanying person(s): No [ ] Yes [ ] How many [ ]
Single accommodation (at extra price): No [ ] Yes [ ]
Date of arrival [ ] departure [ ]
Title of contribution:
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Can be arranged in exceptional cases.