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Summer sessioncelsasorbonne2012(registrationform)
1. 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
