Société Française de Métallurgie et de Matériaux

Société Française de Métallurgie et de Matériaux
Non-profit scientific organization
28, rue Saint Dominique – 75007 PARIS
Tel: +33 1 46 33 08 00 – Fax: +33 1 46 33 08 80
[email protected] - www.sf2m.asso.fr
REGISTRATION FORM 2016
Personal data
Mr. Ms. Dr. Prof. NAME : ................................................. First name: ......................................................
Date of birth (dd/mm/yyyy):
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Business address (University or Company):
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Tel.: .................................. Fax: ........................................
Email address: ...................................................................
Address to be used for communication
Business: 
Personal address:
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Zip Code (before city name) .............................................
City.....................................................................................
Zip Code (after city name) ................................................
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Tel.: .................................. Mob.: .....................................
Email address: ...................................................................
Personal: 
Annual subscription
Active Member
Retired Member
Reduced fee for "Cercle d’Étude des Métaux" Members
 120 €
 60 €
 100 €
Junior Member
 45 €
(less than 35 years old at January 1st of the year)
Undergraduate or Graduate student
 20 €
(please join copy of student card)
Reduced rates - Publications
Additional fee for "ASM international" e-membership
AEM (Advanced Engineering Materials)
 30 €
 120 €
Matériaux et Techniques electronic version
Metallurgial Research & Technology
 575 €
Combined M&T + MRT electronic version
electronic version
 45 €
 65 €
electronic version
IJMR (International Journal of Materials Research)
Payment
 100 €
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Please pay your subscription while returning this form. In a normal year it should be paid before March 31.
When payment is made by your organization, please join a copy of this filled form to your internal request: it should be attached
to the payment notification sent to SF2M (address above).
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Credit card : VISA / MASTER CARD / EURO CARD
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Cardholder’s Name : .................................................
Expiration date I I I/I I I
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I undersigned, give the authorisation to SF2M to charge
my credit card for the total above : .......................................... Euros
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Signature :
Copy of my bank transfer order .............................. Euros to SF2M by fax : +33 1 46 33 08 80
Bank : ..................................................................... Account : ..........................................................
International Bank Account Number (IBAN) : FR76 3006 6101 6100 0103 4140 123
Bank Identification Code (BIC) : CMCIFRPP
(Bank references: Crédit Industriel et Commercial (CIC) - Paris Saint Philippe - 66 rue La Boétie - 75008 Paris
Personal data (continued)
Position:
 Director  Research Director  Associate Director  Head of Department  Head of Service  Engineer  Research Engineer
 Professor  Associate Professor  Assistant Professor  Research Assistant  Others………………. ...................................
Diplomas:
 Doctor degree
 Engineering degree
 Bachelor degree
 Master
 Others .....................
Honours and decorations :
 (please specify)
Distinctions from Société Française de Métallurgie et de Matériaux :
Year
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Grande Médaille
Médaille Chaudron
Médaille Chevenard
Médaille Portevin
Médaille Bastien Guillet
Médaille Sainte-Claire Deville
Médaille Réaumur
Médaille Charles Eichner
Prix Aperam René Castro
Year
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Prix Jean Morlet
Prix Jules Garnier
Prix Mishima
Médaille Jean Rist
Médaille Jacques Pomey
Prix Bodycote-SF2M
Prix Jacques Dalla Torre
Prix ArcelorMittal Pierre Vayssière
Other membership and other scientific distinctions (please specify):
 DGM member / distinction:…………………………………
 IOM member / distinction: …………………………………
 SVMT member / distinction: …………………………………
 AIM member / distinction: …………………………………
 ASM member / distinction: …………………………………
 TMS member / distinction: …………………………………
Others (3 max): ………………………………….... ………………………………….……………….
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