Summer sessioncelsasorbonne2012(registrationform)

international summer session CELSA, Paris-Sorbonne university registr ation form closing date for applic ations: 18 May 2012 Please send your completed registration form by e-mail (pdf or jpg) to the Administrative co-ordinator. Participant Ms ❑ Mr ❑ Surname............................................................................. First name............................................................. Address................................................................................................................................................................. . ................................................................................................................................................................................ City....................................................................................... Postal code.......................................................... Country................................................................................................................................................................. phone number.................................................................. Mobile*.................................................................. E-mail address*.................................................................................................................................................. Registration Fees 1200€ (1000€ for all lessons, and 200€ for all weekday lunches, visits and travel pass) Payment Payment must be made in Euros only ❑ Payment by bank transfer: IBAN (International Bank Account Number): FR76 1007 1750 0000 0010 0579 073 BIC (Bank Identifier Code): TRPUFRP1 Bank: DRFIP Ile-de-France et de Paris, 94 rue Réaumur 75104 Paris cedex 02 France Account holder: Université Paris-Sorbonne, 1 rue Victor Cousin, 75230 Paris cedex 05 France ❑ Payment by cheque (French bank cheques only) Order of “Agent comptable de l’Université Paris-Sorbonne” CONTACT Philip Scheiner - Programme leader Tel.: +33 (0)1 46 43 76 61 Fax : +33 (0)1 46 43 75 10 philip.scheiner@celsa.paris-sorbonne.fr Roselyne Aubert - Administrative co-ordinator Fax : +33 (0)1 46 43 75 10 roselyne.aubert@celsa.paris-sorbonne.fr * necessary information

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Summer sessioncelsasorbonne2012(registrationform)

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