9th INTERNATIONAL CONFERENCE ON
SYSTEM SCIENCE IN HEALTH CARE
Lyon, France
From September 3rd to 5th, 2008
REGISTRATION FORM		 
 
PARTICIPANT DETAILS
 
First name (*) Last name (*)
Organization (*) Phone number
Address 1 (*) Address 2
Zipcode (*) Town (*)
Country (*)   
Email (*) Email (for validation) (*)
Special dietary requirements Other special requests
 
REGISTRATION FEES
 
Please select your status among the following options (only one option per person and per registration form):
 
Status
Payment date (*)
AFTER 10/07/2008
PAYMENT DETAILS
 
GLOBAL AMOUNT IN EUROS
Payment mode (*)
 
Bank transfer
Cheque (from French banks only)
Purchase order (SIRET 49329821000011)
Cash payment on the day (or cheque from French bank on the day)
Credit card payment
 
BILLING ADDRESS
 
Is billing addresse different from contact address ? (*)
 
YesNo
 
 
 
(*) These fields are mandatory