Please, print and fill this form, and send it to Irène Charon
- by fax, number 33 1 45 81 31 19
- or by postal mail to Irène Charon, ENST, 46, rue Barrault, 75634 Paris Cedex 13

First name of the participant:

Name of the participant:

I hereby authorize the ENST to charge my credit card:

Name written on the card:

Number written on the card:

Expiry date:

Amount in euros (*):

Date :                                                            Signature :

(*) : 150 euros for early registration (up until September, 18),
200 euros for late registration (after September, 18)