Inscriptions - Symposium Institut Cochin 2024 "Muscle, Exercise and Health" Remplissez le formulaire ci-dessous, avant le 25 octobre 2024. Family name / Nom First name / Prénom Institute, company / Institut, entreprise Team or department / Équipe ou service City / Ville Country / Pays Email address Email address Email address confirmation Lab Postal Address / Adresse postale du laboratoire Telephone number - Sélectionner - Non academic researcher Academic researcher Engineer Post-doc PhD student Speaker Organizer Sponsor representative Internship Other Position / Statut YES NO Do you wish to attend the Dinner on 14/11? / Souhaitez-vous participer au cocktail dinatoire le 14/11 ? YES NO Do you wish to attend the Lunch on 15/11? / Souhaitez-vous participer au déjeuner le 15/11 ? - Sélectionner - Non academic researcher or engineer: 160 € Academic outside Institut Cochin: 100 € Academic at Institut Cochin: 50 € Student outside Institut Cochin: 40 € Student at Institut Cochin, organizer, speaker: free registration fee categories / Tarifs d'inscription - Sélectionner - Purchase order Bank check Wire transfer Bank card NONE Method of payment / Moyen de paiement After submission of your registration form, you will receive a proof of registration at the email address you provided. Administrative contact for any question about the payment process: apemm.cochin@gmail.com For payment by purchase order, the orders must be addressed to: APEMM, 24 rue du Faubourg St Jacques, 75014 PARIS. Please ask your administrative manager to group the registrations of team members in order to generate a single purchase order For payment by check, send the check (payable to APEMM) and the proof of registration, to APEMM: 24 rue du Faubourg St-Jacques, 75014 Paris For payment by wire transfer: APEMM GESTION - CAISSE D'ÉPARGNE ILE-DE-FRANCE, IBAN : FR76 1751 5900 0008 0119 2961 251 ; BIC : CEPAFRPP75 For payment by bank card, please pay online via Hello asso platform: the url link will be provided very soon, by e-mail. Full billing address (if different from the above address) / Adresse où envoyer la facture (si différente de la précédente) Laisser ce champ vide Contacts For organization issues Contacter par mail For payment issues Contacter par mail