Registration

Conference on "Quantitative methods in statistics, biostatistics
and actuarial sciences"

Wednesday, May 30 - Friday, June 01, 2012
Louvain-la-Neuve

The fields followed by an asterisk (*) are compulsory.

* Family Name :
* First Name :
* E-mail address :
* Are you invited speaker or member of IMMAQ ?	Yes No
Institution :
Postal address :

I will attend the "Doctor Honoris Causa" ceremony and the reception (free of change)
Thursday May 31, afternoon ceremony and reception	Yes No

Registration for the scientific programme The regular registration fee is 120 €, there is a reduced fee of 80 € available for master or Ph.D. students (proof required) and SBS/BVS members only. Your registration will be validated after your payment has been received. After April 30, 2012, the registration fee will increase by 50%.
Register for scientific programme	Yes No
Master or Ph.D. student or SBS/BVS member	Yes No

Will take part in :
Tuesday May 29, afternoon short course by Jon Wellner	Yes No
Wednesday May 30, morning short course by Jon Wellner	Yes No
Wednesday May 30, afternoon session on "Actuarial and Financial Risks"	Yes No
Thursday May 31, morning session on "Mathematical statistics"	Yes No
Friday June 01, morning session on "Biostatistics"	Yes No

Registration for the conference dinner For the participation at the conference dinner there applies an additional fee of 60 € per person. Please indicate in the comment box below if you will be accompanied by a guest.
Register for conference dinner on Thursday evening	Yes No

Do you need an invoice ?	Yes No
If so, please complete the billing details below:
Company :
VAT number :
Billing adress :
If you have a comment or a special request regarding this registration (e.g. dietary requests such as vegetarian meals or if you are accompanied by a guest), please write it in the following box:
Comments :

For any question about this form, please contact Tatiana Regout at: tatiana.regout@uclouvain.be

| 23/01/2012 |