INSTITUT NATIONAL DES SCIENCES
ET TECHNIQUES NUCLEAIRES
MICROPET AND MICROPET/MR IMAGING SCIENCE
Cambridge (United Kingdom) – November 9-13, 2009
Please complete the registration form and send it by email, fax or regular mail to:
EMIL – DiMI Training Office
INSTN / UGL / BCSE – Centre CEA de Saclay – 91191 Gif-sur-Yvette Cedex – FRANCE
Phone: +33 1 69 08 25 02 – Fax: +33 1 69 08 97 77 – e-mail: emil-dimi.training@cea.fr
Last name: ....................................................First name: ................................................................
Date & place of birth (Month/Day/Year): .........................................................
Gender:  F
M
Nationality: ................................................. Nationality at birth if different: …………..………………
Institution/Company: ........................................................................................................................
Address of invoice: .........................................................................................................................
City Code: ........................ City: ..................................................... Country: ..................................
Telephone: .......................................................... Fax: ....................................................................
E-mail: ................................................................ Web site: ............................................................
Is your laboratory member of the DiMI / EMIL / MOLIM Network:
Position:
yes 
no 
graduate student 
post-doc 
researcher 
physician 
professor 
technician 
other (specify): ......................................
Registration fees can be paid either:
 by check: to the order of CEA Saclay
 by bank transfer:
Account holder
Bank name
Bank branch address
Bank account number
IBAN
BIC
CEA EMIL DIMI
BNP PARIBAS
BNP PARIBAS PARIS AG CENTRALE
30004 00818 00012399309 27
FR76 3000 4008 1800 0123 9930 927
BNPAFRPPPVD
It is mandatory to mention on the bank transfer the name of the participant and the course attended.
If your Account Department requests a special mention on the invoice, please be so kind to
indicate it here: ………………………………………….
 DiMI / EMIL / MOLIM members: 100€ - Public institutions: 400€ - Private institutions: 700€
EMIL – DiMI Training Office
INSTN / UGL / BCSE – Centre CEA de Saclay – 91191 Gif-sur-Yvette Cedex, FRANCE
Phone: +33 1 69 08 25 02 – Fax: +33 1 69 08 97 77 – e-mail: emil-dimi.training@cea.fr
INSTITUT NATIONAL DES SCIENCES
ET TECHNIQUES NUCLEAIRES
We would like to know more about your interest on molecular imaging technology. Therefore
we invite you to answer to the following questions.
Research interest:
-
Why would you like to attend this course?
-
Publications on molecular imaging, if any:
-
EMIL – DiMI Training Office
INSTN / UGL / BCSE – Centre CEA de Saclay – 91191 Gif-sur-Yvette Cedex, FRANCE
Phone: +33 1 69 08 25 02 – Fax: +33 1 69 08 97 77 – e-mail: emil-dimi.training@cea.fr