Mrs Miss Mr
	Name :
	First name :
	Function :
	Company / Organization :
	Activity of your Company :
	Address :
	Address complement :
	Area Code :
	City :
	Country :
	Telephone (direct line) :
	Fax :
	Mobilephone :
	eMail :
	Web site :

Tuesday June 28
I wish to visit the exhibition
I would to attend the morning plenary session :Program available from 1 May, 2011
I would to attend the afternoon session :Program available from 1 May, 2011

Wednesday June 29
I wish to visit the exhibition
I would to particip to the workshop 1: Program available from 1 May, 2011
I would to particip to the workshop 2: Program available from 1 May, 2011
I would to particip to the workshop 3 : Program available from 1 May, 2011
I would to particip to the workshop 4: Program available from 1 May, 2011
I would to particip to the workshop 5: Program available from 1 May, 2011
I would to particip to the workshop 6: Program available from 1 May, 2011
I would to particip to the Scilab annual Users Day : ScilabTec'11

Information that you provide us on this form, in conformity with the IT and freedom law of 1978, is necessary for Ter@tec can treat your registration with this Forum and to address information concerning its events to you.
You can at any time to reach this information, to ask for correction or to exert your right of opposition of it.

With this intention, you address to Ter@tec, Bard1- Domaine of Main street - 91680 BRUYERES-LE-CHATEL, or with : jean-pascal.jegu@teratec.fr