To pre-register to GASCom 2012 and/or to the Journées in honour of Xavier G. Viennot, please fill in the following form and send it by email to gascom.registration@labri.fr Registration will be confirmed once we received your payment. First name : Last name : E-mail address : Affiliation : Address of affiliation : I will attend GASCom 2012 (June 25-27): _ Yes _ No I will attend the Journées X.G. Viennot (June 28-29): _ Yes _ No I pay the student fee (a proof of student status is required): _ Yes _ No Mean of payment: _ Bank transfer _ Bank card (MasterCard or Visa), sending the payment form by E-MAIL _ Bank card (MasterCard or Visa), sending the payment form by FAX _ Bank card (MasterCard or Visa), sending the payment form by POSTAL MAIL _ Bon de commande (if you come from a French organization only) _ French check (if you have a French bank account only) I have an accompanying person: _ Yes _ No Please write any further comment here (health constraints, dietary restrictions,...):