Higgs Hunting 2012 Higgs Hunting 2012
Conference registration Form
Fields with a star * are mandatory
Personal Data
Family Name*
 First Name*
Professional Contact Information (address requested by your institution for every receipt/invoice)
Institution*
Address*
City*
Postal code/Zip*
Province/State
Country*
Phone*
Email*
Fax
VAT number
Arrival and Departure
Arrival date
Departure date
Special requirements
Registration
Registration Fee
Registration fee includes: conference organisation, coffee breaks, saturday's lunch (only), welcome drink (thursday evening)...
Payment
Cash upon registration on Thursday: 140 euros

Bank Transfer Information

to the HIGGS HUNTING bank account:

Bank: TRESOR PUBLIC
Account holder name: Agent Comptable du CNRS - Secteur Ile de France Sud
Agency: 27 rue des Mazières 91011 Evry
Bank Code: 10071
Branch No: 91000
Account No: 00001001722
Key: 33
Swift/Bic: BDFEFRPPXXX
IBAN: FR76.1007.1910.0000.0010.0172.233

The transfer should clearly indicate your name to identify the payment.
An Email notification should be sent to the HIGGS HUNTING secretary ( higgs_hunting - at - lal.in2p3.fr ) and
a copy of the bank transfer should imperatively be handed to the Secretariat on arrival at the conference site.

Please note that the bank transfer fee are at the participant charge.
Credit Card (payment in advance)
For this type of payment a signed form is required (form).
THIS FORM HAS TO BE SEND BY POST TO:

Higgs Hunting 2012 - Mme Valérie Brouillard
Laboratoire de l'Accélérateur Linéaire
Bât. 200 - BP 34 - 91898 ORSAY CEDEX - FRANCE
Bon de commande (for people working in a CNRS laboratory; this includes IN2P3 Labs)