REGISTRATION SHEET

LAST NAME:  

FIRST NAME:  

ADDRESS:  

POSTAL CODE/ZIP:  

CITY:  

PROVINCE/STATE:  

COUNTRY:  

PHONE NUMBER:  

FAX NUMBER:  

E-MAIL ADDRESS:  

If Professional:

AFFILIATION:  

ADDRESS:  

INDUSTRY:  

FUNCTION:  

EMPLOYEE NUMBER:  

If Student:

UNIVERSITY:  

FACULTY:  

DEGREE:  

PROGRAM OR DEPARTMENT:  

GRADE:  

STUDENT NUMBER:  

Check one of the following:

Students registered in the Province of Québec

Students registered outside of the Province of Québec

Others

Payment Terms:

Don't forget to include your check with the Registration Sheet.

Credits will be granted only if the agreements between the university faculties are authorized and a written proof is received. Students who want to get credits for the courses taken as part of the summer institute check two of the following courses: