registration form

appellation	Mr Mrs
family name
given name
institution
postal address
country
email
accommodation (name of hotel)
registration fee 550 euro (paid before June 10, 2010) 650 euro (paid after June 10, 2010) 380 euro (Ph.D. student)
social events Monday July 12: Belgian beer reception and buffet (free of charge) Wednesday July 14: symposium dinner (70 euro p.p.)
total fee (euro)
payment	bank order (taxes paid by participants) cash at the symposium desk
Account nbr 340 - 1508861 - 64 entitled UCL-Symposium "Catalysts" IBAN : BE29 3401 5088 6164 BIC: BBRUBEBB Name of the bank: ING, rue des Wallons 2, B-1348 Louvain-la-Neuve, Belgium with the mention: "PREPA10 registration" and your name.
This form must be sent back before June 1st, 2010 to prepa10@uclouvain.be or to Unité de catalyse Croix du Sud 2/17 B-1348 Louvain-la-Neuve (Belgium)

| 25/02/2010 |