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{\bf\Large Registration - {\it Inscription}}\\
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\underline{\bf Deadline ({\it date limite}): 15 april 2013}\\
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Please fill this form and return it by e-mail to: \\
({\it Pri\`ere de remplir ce formulaire et de le renvoyer par mel \`a:})
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daniel.li@euler.univ-artois.fr \par 
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\noindent {\it and to}\par

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fricain@math.univ-lille1.fr
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Please note that this inscription is independent of the inscription to Lille workshop ({\it Veuillez noter que l'inscription aux Mini-cours de Lens se font ind\'ependemment 
de celles au Workshop de Lille}).
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\noindent {\bf Surname} ({\it Nom}):

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\noindent {\bf First name} ({\it Pr\'enom}):

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\noindent {\bf Affiliation (university)}:

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\noindent {\bf Status} (Ph.D. Student, post-doc, professor, researcher, \dots):

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\noindent {\bf Date of arrival} ({\it date d'arriv\'ee}):

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\noindent {\bf Date of departure} ({\it date de d\'epart}):

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\noindent {\bf Do you wish that we book a room for you?} ({\it voulez-vous que l'on vous r\'eserve une chambre?})

\noindent {\bf In which hotel?} [It will H\^otel de France for participants supported by the short-courses] ({\it dans quel h\^otel?}) 

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\noindent {\bf Will you agree to share a room?} ({\it acceptez-vous de partager une chambre?}): 

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\noindent {\bf Suggested person for sharing the room} ({\it avec qui souhaitez-vous la partager?}): 

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\noindent {\bf Do you wish to give a talk?} (1/2 hour) ({\it voulez-vous faire un expos\'e?}): 

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\noindent {\bf Title} (if yes) ({\it titre}):

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\noindent {\bf Abstract} ({\it R\'esum\'e}): 





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