First International Workshop on Functional Imaging and Modeling of the Heart

FIMH’2001 : First International Workshop on Functional Imaging and Modeling of the Heart

Helsinki, November 15-16, 2001

Registration

Early registration is now closed. The registration fees include entrance to all sessions, 2 lunches, the reception at the French Embassy, and proceedings.

To register, please complete this form in CAPITAL LETTERS and return together with payment/credit card number to:

Johan Montagnat

FIMH, Creatis, INSA bât. B. Pascal

20 av. A. Einstein

69621 Villeurbanne

France.

Family Name: ____________________________ First name:________________________
Organization:_____________________________ Department: _______________________
Mailing Adress:______________________________________________________________
Zip/Area code:______________ City:_____________________________
Country:_____________
Phone :__________________________________ Fax:______________________________
e-mail:(in capital letters) _____________________@________________________________
Senior : ______ x 180 Euros

Total amount due : ______ Euros

PAYMENT

Please indicate form of payment below. All payments must be made in Euros.

• 
  Bank transfer (in Euros) to “Banque populaire Loire et Lyonnais, Villeurbanne, France” account number: Bank code number key
  

13907 00000 00231938682 65

• 
  Check (in Euros), to “INSAVALOR S.A. ”
  

• 
  Credit card:
  

VISA DINERS AMERICAN EXPRESS MASTER CARD EURO CARD

Name on card:_____________________________________________________________

Card number: ___________________________ Expiration date ___________________

Date:________________________ Signature _____________________________________

http://www.creatis.insa-lyon.fr/FIMH/ 10/08/2018