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We invite you to complete the form below and send it before September, 30, 2016
to ISIVC’2016 secretariat by Email to: ISIVC2016.secretariat@supcom.tn
with payment justification

Attendee informations:  Registration Form ISIVC 2016

First name:…………………….…….Last (family) name:…………………………………….

Title:             Pr ο         Dr ο                Industrial ο                                 Other ο

Affiliate/Company:.………………………………………………..……………………………….

Address:……………………………………………………………………………………………………

Code:………………….City:……………… …………………Country: …………………………..

Phone: (+……) ….……………………E-mail: ……………..……………………………………….

Paper number(s) you are covering: …………… / …………… (2 maximum)

Registration fees:

  Type Fees Choice
Member of local laboratories Formula (1) 400 DT 
Formula (2) 700 DT 
Full registration Formula (3) 350 € 
Formula (4) 600 € 
  • Formula (1) and (3) include admission to all scientific sessions, CD-ROM, coffee breaks, lunchs and social activity.
  • Formula (2) (reps. (4)) include formula (1) (resp. (3)) and lodging with breakfast and dinner for three days (November 20, 21, 22).

Payment:

The registration fees must be free of charges or bank commission.

 

Please choose one of the following payment mode

  •  Check to the order of «Association des diplômés de SUP’COM Tunis», send with the registration form (please indicate the participant’s name)
  • Credit Card

Credit card type:
Card Number:
Expiration date (Month/year):
Card holder’s name:
Card holder’s signature                                   CCV2 code

  • Bank transfer: send the swift with the registration form

Account holder: Association des diplômés de SupCom Tunis
Account number: 04034120 004075571274
IBAN: TN59 04034120 004075571274
Code BIC: BSTUTNTT
Bank: ANGLE DE AVENUE FETHI ZOUHEIR ET RUE DE PALESTINE CP 2083 – Ariana

  • Bon de commande mécanisé’ for Tunisian participants:
    Name: Association des diplômés de SupCom
    Activity: association
    Adress: Ecole Supérieure des communications, Route Raoued, Km3.5, 2088, Tunis-TUNISIA
    Tax identification number: 1413383/H
    include it with registration form, adress it directly or send it by mail to:

Prof. Sofiane Cherif
Ecole Supérieure des Communications
Route Raoued Km 3.5, Cité El Ghazala
2083 TUNIS, TUNISIA