French version
3 - 5 novembre 1999 Université du Littoral, Dunkerque, France

Please return to:

First Name : ..............................

Last Name : ...............................................

Institution : ..........................................

Address : ..............................................

          ..............................................

Zip - Post Code : ...........   City : ....................

Country : ..................   Email : .....................

Phone. : ..................   Fax : .....................

Registration 800 FF (121,96 Euros) ( )    Before October 15th
             950 FF (144,83 Euros) ( )    After October 15th

Method of Payment:

• you can pay by cash at the registration desk upon arrival
• you can pay by bank transfer
• you can pay by cheque

You MUST send this form to register even if you choose to pay at the registration desk.

Method for payment :

cheque: Payment should be made to:

AGENT COMPTABLE UNIVERSITE DU LITTORAL

Bank Transfer:

Bank Name: LA POSTE

Agency: LILLE

Address: 59900 LILLE CHEQUES

Order: Agent Comptable Université du Littoral

Your id: "Your Name" - Evolution Artificielle'99

Cash at the registration desk