Mrs Ms Mr
	Name:
	First name:
	Company / Organization:
	Function:
	Department / Service:
	Address:
	Zip code:
	City:
	Country:
	Phone:
	Fax:
	eMail :
	Comments / Questions

Acceptance / Refusal of data collection

By checking this box,, I agree that my information entered in this form will be stored in a database administered by Teratec and for the only purpose of organizing the TERATEC / NAG Seminar.

Prospective participants should note that part of the registration data will be shared with NAG and NAG may use the data of participants after the workshop to get feedback and to communicate relative information.

If you don't check this box, you understand that you will not be able to participate in the TERATEC / NAG Seminar.