Title: Dislocations 2004
Author: B. Devincre
Last saved by: Benoit Devincre
Company: CNRS

‘DISLOCATIONS 2004’ - ACCOMPANYING PERSONS RESERVATION FORM
‘La Colle-sur-Loup’, FRANCE, September 13 – 17, 2004

Please print out two copies of this form (use CAPITAL LETTERS) and return the forms by mail or by fax to:

Sylvie MONMAYER
VVF la Canterelle “La Bergerie”
Chemin de Montmeuille                            and
F – 06480 La Colle-sur-Loup
FRANCE
Fax : +33  4 93 32 54 18

Benoit DEVINCRE
LEM, CNRS-ONERA
BP 72, 29 av. de la Division Leclerc
F – 92322 Chatillon CEDEX
FRANCE
Fax : +33  1 46 73 41 55

NAME : Mr / Ms /Mrs

……………………………………………..
(Last or family Name)

……………………………………………..
(First or Given Name)

NAME : Mr / Ms /Mrs

……………………………………………..
(Last or family Name)

……………………………………………..
(First or Given Name and age if less than 16)

NAME : Mr / Ms /Mrs

……………………………………………..
(Last or family Name)

……………………………………………..
(First or Given Name and age if less than 16)

ADDRESS:
……………………………………………………………………………………………………………….………………………………….………………………………………………………………………………………………..…….

City :……………………………… | Postal code /ZIP : ……………………. | Country :…………………………
Phone :    ……………………………………..                                Fax :……………………………………..
E-mail : …………………………………….……………………………………..……………………………………..

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ACCOMPANYING PERSON NAME:
(The person registered to “Dislocations 2004”)

……………………………………………..
(Last or family Name)

……………………………………………..
(First or Given Name)

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Comments and particular request:

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	Dear Sir/Madam

I hereby confirm my reservation at the ‘VVF la Canterelle’

from (arrival date):				to (leaving date): 

as a person accompanying Mr/Ms: 			          who is registered to the conference ‘Dislocations 2004’ to be held at the ‘VVF la Canterelle’ (September, 13-17, 2004).

For my stay, I agree to pay on site directly to VVF, an extra rate of 67€ /day/person including my lodging and a full board (breakfast, lunch and dinner).

		Sincerely yours

										(Signature)