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18th INTERNATIONAL CONGRESS on

MARINE CORROSION and FOULING • 18th ICMCF

19-24 June 2016 • University of Toulon, Toulon, France

SPONSORSHIP REGISTRATION FORM

Laboratoire MAPIEM, SeaTech • Université de Toulon, BP 20132 • 83 957 La Garde Cedex FranceTel. +33 4 94 14 25 80 • Email: icmcf@univ-tln.fr

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18th ICMCF • 19-24 June 2016 • University of Toulon • Sponsorship Registration FormSP

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Please return this form before: January 31th 2016 to the following address:

Anne DELARUELaboratoire MAPIEM • SeaTech École d’IngénieursUniversité de Toulon, BP 20 132 • 83 957 La Garde Cedex, FranceEmail: delarue@univ-tln.fr

� CompAny infoRmAtion

Company name: Contact person: Address:Post code: City: Country:Telephone: Fax: Email:

N° SIRET:N° TVA Intracommunautaire:

� invoiCE infoRmAtion

Company name: Contact person: Address: Post code: City: Country: Telephone: Fax:Email:

� SponSoRShip pAymEnt AnD REgiStRAtion

� payment information

PAyMENT

• 50% deposit (including VAT)• Final balance (including VAT)• No later than May 1st 2016• Payment information

Bank transfer payable toUNIVERSITE de TOULONAgence ComptableAvenue de l’Université BP 20 132 • 83 957 LA GARDE Cedex

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• Université de Toulon (UTLN) Bank informationBank code: 10 071Sort code: 83 000Account number: 00001006169Key: 89BIC/SWIFT code: TRPUFRP1Intra-community VAT number: FR 761 983 07 662Nb: Bank charges may be applied to all international payments (Company charges)

CANCELLATION

• Before January 31st 2016:Reimbursement of deposit paid less administrative fees of 250 €

• Before March 31st 2016:Reimbursement of 50% of the total cost

• After March 31st 2016:No refund

� payment/Registration

Sponsorship categoriesCost

(including vAt)

total

Exhibition sponsorship packagesPlatinum Plan 10 000 €Golden Plan 5 000 €Silver Plan 2 000 €Bronze Plan 1 000 €f&B Conference kit sponsorship packagesCoffee Break (per break) 2 000 €Opening Lunch Buffet 7 000 €Main Event : Welcome Reception 10 000 €Main Event : Poster Session-Dinner Cocktail 10 000 €Exhibition opportunitiesCorporate boxes 2 500 €Other Conference Sponsorship opportunitiesConference Bags (Single Sponsor only) 5 000 €Conference Lanyards (Single Sponsor only) 3 000 €Corporate Literature in Conference Bags 1 500 €Corporate Literature in Conference Book 1 500 €Logo and Link on the Conference Website 800 €

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other types of sponsorshipFinancial GrantsStudent Travel Financial Grantyoung Researcher Poster Prizeyoung Researcher Oral Communication Prize

Total (including VAT)50% deposit (Including VAT)

other types of advertisements QuantityDonationsUSB KeysPadsPens (to be included in conference bags)Bronze PlanConference gifts:

Please provide the names of your Company’s representatives who will receive complimentary registrations and lunch passes according to the terms of sponsorship above:

Title: Surname: First name:

Title: Surname: First name:

Title: Surname: First name:

Title: Surname: First name:

I, the undersigned, (name of the company representative)

certify that I have read and accept all reservation conditions outlined above.

Date Signature Company stamp (obligatory)