Spring School on Transportation
Registration Form

Please print this form, fill it and send it to the address below, together with your payment.
Chaire de recherche du Canada en distributique
HEC Montréal
3000, chemin de la Côte-Sainte-Catherine
Montréal, Canada H3T 2A7

If you pay by credit card, you may also send this form by fax at (514) 340-5665, care of Carole Dufour.

 
Payment Mode

  ___ check *

  ___ money order *
  ___ Visa

  ___ MasterCard
  _____________________
 		  Credit Card Number
  _____________________
 		  Expiry Date
  _____________________
 		  Signature
 

Registration Fee ($ CDN):

____   175 $, until February 28, 2006
 
____   250 $, after February 28, 2006
 
____   100 $, Students
 
   This fee includes a reception on Wednesday night.
*Checks and money orders must be drawn from a Canadian bank in Canadian dollars and made payable to HEC Montréal.


Attendee

Name _______________________________________________________________________
 
Affiliation _______________________________________________________________________
 
Address _______________________________________________________________________
 
City ______________________________
 		 Prov./State ______________________________
 
Country ______________________________
 		 Postal Code ______________________________
 
Phone ______________________________
 		 Fax ______________________________
 
Email _______________________________________________________________________