UHPFRC 2017 Montpellier – October 2 nd to October 4 th , 2017 Registration Form TO BE FILLED AND SENT WITH PAYMENT TO THE SECRETARIAT OF AFGC, BY SEPTEMBER 20 th , 2017 Mr Mrs Dr Prof. Surname Function First Name Company Address Zip Code / City Country Phone Fax E-mail Billing address (if different) Symposium Registration fees – Before June 1 st , 2017 Symposium Registration fees – After June 1 st , 2017 AFGC, fib, RILEM or ACI Member 500 € AFGC, fib, RILEM or ACI Member 600 € Non-AFGC, fib, RILEM or ACI Member 550 € Non-AFGC, fib, RILEM or ACI Member 650 € French Administration, Students 250 € French Administration, Students 300 € Accompanying person 150 € Accompanying person 200 € TOTAL The registration fees for the Symposium UHPFRC 2017 include: access to all lectures, complete paper and electronic version of RILEM PRO 106 Proceedings, lunches of October 2 nd , October 3 rd and October 4 th , coffee breaks during the conference and Banquet Dinner on October 3 rd . Payment For any cost or commission occurred through bank transfers, this will be at charge of each delegate. Important: for bank transfers, please stipulate your name and AFGC-UHPFRC 2017. Send a copy of the bank transfer with your form. Bank transfer to AFGC Account number: BNP PARIBAS 30004 00066 00010003793 67 Swift Code: BNPAFRPPMAS IBAN: FR76 3000 4000 6600 0100 0379 367 For the registrations made with an order form, there are two stages: the participant will receive a pro-forma invoice upon receipt of the order form, then a paid invoice upon receipt of the payment Tick the appropriate boxes I will attend lunch on October2 nd , 2017 I will attend lunch on October3 rd , 2017 I will attend lunch on October 4 th , 2017 I will attend Banquet Dinner on October 3 rd , 2017 Cancellation Cancellation before September 20 th , 2017 : 80% of the registration fees will be refunded Cancellation after September 20 th , 2017 : No refund