VIRTUAL WORLDS 98 CONFERENCE REGISTRATION FORM Now please copy this form and email/fax to Sophie.Dussault@devinci.fr. Name _____________________________________________ Institution ______________________________________ __________________________________________________ Address __________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Email ____________________________________________ Phone _____________________ Fax __________________ Pedagogical Session Choice (optional): ___________ REGISTRATION FEES (FF) NORMAL FULL REGISTRATION: 2500 ________ or EARLY FULL REGISTRATION: 2000 ________ or NORMAL STUDENT REGISTRATION: 1000 ________ or EARLY STUDENT REGISTRATION: 800 ________ and optional BANQUET TICKET (subsidised): 250 ________ and optional EXTRA PARTNER (unsubsidised): 300 ________ and optional PEDAGOGICAL SESSION: 500 ________ REGISTRATION FEES TOTAL: ________ I am paying by the following method (check one): ____ Credit Card by mail. ____ French cheque. ____ Eurocheque. ____ Bank Draft in French Francs drawn on French bank. "I confirm I am sending payment immediately by the above method!" Signed ____________________ Date _________________ THE COMPLETED FORM SHOULD BE (E)MAILED OR FAXED TO : Sophie DUSSAULT Institut International du Multimédia POLE UNIVERSITAIRE LEONARD DE VINCI 12, avenue Léonard de Vinci 92916 PARIS LA DEFENSE CEDEX FRANCE Tel: +33 01 41 16 75 71 Fax: +33 01 41 16 75 75 Sophie.Dussault@devinci.fr