FRC 2014 Joint ACI-fib International Workshop Fibre Reinforced Concrete: from Design to Structural Applications Registration form Comments Fill information in grey cells of tables below and send it to frc2014@polymtl.ca. The registration payment can be made for individual participant by PayPal or bank transfer. The registration payment can be made for group of participants only by bank transfer. Fill one general information section for each participant. Put the total registration costs for the group of participants. General information First Name Last Name Professional title Institution Address: Country Email Telephone Author Speaker Banquet Yes, provide the paper number : No: Yes : No: If more than one ticket of banquet is needed, indicate number here: Supplementary ticket will be sold at the conference if places are available. Registration costs The registration costs include a copy of the proceedings, lunches, refreshments at breaks, and banquet dinner to be held at Hôtel Nelligan in Old Montreal for the full registrants. Student registration and one-day registration do not include banquet. Registration type Early registration (payment due on 31/05/2014) Late registration (payment due on 30/06/2014) Student registration * (payment due on 31/05/2014) One-day registration (payment due on 30/06/2014) Bank transfer fee (not applicable for PayPal payment) Fee Number of participants Amount 450 $CAN 525 $CAN 300 $CAN 300 $CAN 40 $CAN Total * A scan of a valid student card or attestation must be sent with the registration form. 1 FRC 2014 Joint ACI-fib International Workshop Fibre Reinforced Concrete: from Design to Structural Applications Registration payment Select the payment method with a ‘X’ in the first column of the table below. Provide the information required in grey cell in the last column when applicable. PayPal Instructions 1- Go to the conference web site www.polymtl.ca/frc2014/. 2- Go to the registration page. 3- Find the PayPal portal (see image below) and select the registration type. 4- You will be transfer on PayPal website, make the payment. 5- Indicate the transaction number provided by PayPal in the cell below. Transaction number provided by PayPal Amount paid OR Bank transfer Note 1 Note 2 Amount paid Account owner Beneficiary Address Bank Name Bank Address Account number Swift code Transit Mention to indicate on the document 2 Do not forget to add the bank transfer fee of 40 $CAN in the registration cost. Provide the information below to your bank. Ecole Polytechnique de Montréal 2500 Chemin Polytechnique Montréal (Québec) H3T1J4 Caisse Populaire Desjardins 1, Complexe Desjardins, Suite 2822 Montréal, Québec, Canada H5B 1B3 MFI02190140815CAD0 CCDQCAMM 0815-98000 FRC2014 Conference (Prof. J-P Charron) FRC 2014 Joint ACI-fib International Workshop Fibre Reinforced Concrete: from Design to Structural Applications Transmission of information Name your registration form file with your family name. Send your registration form to frc2014@polymtl.ca. Add your student attestation to the message if applicable. 3