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Water Risk Seminar Participation Bulletin - Aix-en-Provence, Dec. 19, 2013

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Register for the Water Risk Seminar and confirm your attendance by filling out the bulletin with payment details. Sending the completed form by mail is required for registration.

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Water Risk Seminar Participation Bulletin - Aix-en-Provence, Dec. 19, 2013

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  1. En partenariat avec : BULLETIN DE PARTICIPATION Eau 19 décembre 2013 - AIX EN PROVENCE Adhérent du Pôle :150€HT Soit 179,40€ TTC Non adhérent : 200€HT Soit 239,20€ TTC Bulletin à retourner par courrier* CONFIRMATION & PAIEMENT : Adresse du participant Raison sociale : ..................................................................................................................................................... Adresse : ............................................................................................................................................................... CP : ..................... Ville : ............................................................................................. Tél : ................................ Fax : ................................ Contact M/Mme : .............................................................................................................................................................. Fonction : .............................................................................................................................................................. Tél : ................................ Mail : .................................................................................................................................................................... Le règlement par chèque est à retourner par courrier à l’ordre de Pôle Risques à l’adresse suivante : POLE RISQUES Domaine du Petit Arbois – Avenue Louis Philibert – Bât Poincaré 13 857 AIX-EN-PROVENCE CEDEX 3 CONTACT Pôle Risques : lucile.lallie@pole-risques.com / Tél : 06 01 20 83 93

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