Registration & Payment Form - Château Saint André Center for Ethics and Integrity

Please use the following form to arrange for registration and payment of your attendance. The same form can be used for payment of the registration fee, lodging, the accompanying person fee, or any other payment owed. Please use the following table to calculate your total fee (in Euros):

Colloquium fee: Euro 560
Accompanying person fee: Euro 350
Accommodation at the retreat center: Euro 235 (based on single occpancy, incl. breakfast)
Accommodation fee for each additional person sharing a guest room at the retreat center: Euro 175 (including breakfast)

There are two ways of paying:

(1) PAYPAL. PayPal can process most major credit cards as well as direct bank account withdrawals. You do not need to have or create a PayPal account in order to use this payment method. Once you complete the form below, you will automatically be routed to the PayPal site.

(2) IBAN. If you are residing in Europe and you have a bank account with an IBAN number, we kindly request that you use this option to wire your fee (in Euros) to our France-based bank. PayPal will withhold approximately 5% from the payment you make; in contrast, IBAN transfers arrive in full at the Center’s account. Please complete the form below and select the IBAN option. Then make a manual wire transfer from your own account to our account. We will email you the back account information you will need to make an IBAN transfer.

Please contact us at info[at]chateausaintandre.center or call +33 (0)7 89 67 69 82 if for any reason the form does not work or you have questions regarding the payment process.

Are you registering and paying for yourself or for somebody else? *

I am the registrant and paying for myselfI am paying for somebody else (you will first be asked to provide the registrant's name, contact and travel information, and then your own name and contact information)

Event for which you are registering *

Prefix of the registrant

First name of the registrant

Last Name of the registrant

Street address of the registrant

Apartment, suite, etc. of the registrant

City of the registrant

State/Province of the registrant

ZIP / Postal Code of the registrant

Country of the registrant

Email Address of the registrant *

Phone (cellular/portable) *

Phone (landline)

Do you need a visa to travel to France (and hence need an official letter of invitation )?

YesNo

Date of birth of registrant (required if Visa invitation letter is needed; otherwise optional)

Day

Month

Year

City of birth (required if you need a Visa invitation letter) *

Your nationality (required if you need a Visa invitation letter) *

Please list any dietary restrictions *

Are you sharing your guestroom with another seminar participant (who is registering separately)? *NoYes (please provide his/her name below)

Please enter this person's name

Are you being accompanied by a person who is NOT attending the academic program, but the social program instead? *NoYes (please provide his/her name below)

Please enter accompanying person's name

Please list any dietary restrictions of your accompanying person

Date of birth of accompanying person (optional)

Day

Month

Year

Your expected arrival date and time in Avignon (where you will be picked up by car) *I expect to arrive in Avignon in the course Friday, the start date of the colloquiumI expect to arrive one or more days before the start of the colloquium (and will spend those nights at an Avignon hotel/B&B)I expect to arrive only after the start of colloquium (please specify in the text box for additional travel info below)I do not yet know when I will be arriving in Avignon

Will you be able to stay until the end of the event on Monday evening? *Yes, I will attend until the end of the event, including the Monday final dinnerNo, I will have to leave on Monday afterrnoon before dinnerNo, I will have to leave even earlier (please specify below)

If you have to depart on or before Monday, please provide your expected departure date and time below

Please add any additional information about travel already planned or booked

As a Colloquium participant, what role would you like to play (select all that apply)?

I will prepare a draft paper (due one month in advance of the start)I can prepare a short commentary on a paper by somebody elseI can moderate a (breakout) sessionI can takes notes during a (breakout) session to facilitate the generation of a colloquium statement at the endI prefer not to assume any of the roles above but will of course engage in the discussionsUndecided - please contact me to discuss

Tentative title of your paper

Please provide an abstract of the paper you intend to prepare

I am using this payment form to pay for: *Registration of the colloquium participantAccompanying personRegistrant and accompanying personOther charge (please specify below)I am not currently making any payments (please explain below)

Specifcation / Explanation regarding payment *

Prefix of paying person if different from registrant

First name of paying person if different from registrant

Last name of paying person if different from registrant

Street address of paying person if different from registrant

City of paying person if different from registrant

State/Province of paying person if different from registrant

ZIP / Postal Code of paying person if different from registrant

Country of paying person if different from registrant

Phone connected to mode of payment

Email address of paying person

I wish to pay in the following manner: *Via PayPalVia IBAN (see transfer instructions in email)Yet another payment method (please specify below)

Please specify alternate method of payment

Please enter total fee to be paid in Euros *

EUR

Please add any further comments or questions