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This section has to be completed by the Main Contact Person of the Participant Company to confirm that the payment of the fees related to the registrations of the company and its participants has been done.

The Main Contact Person has to insure that the payment corresponds to the Proforma Invoice sent by LAN after the Registration Form is completed.

The registration is considered binding as soon as the payment of the participation fees has been processed and confirmed

Confirmation of Payment

Company Registration Number*
Main contact person email*
I confirm that the following payment has been done for the participation of my company to the 3rd XGS-PON Interoperability Test Event:
Type of Payment*	Bank Transfer   Check
Amount*
Currency*	USD ($)   EUR (€)
Date of Payment*
Check Number*

* fields that must be completed

Laboratoire des Applications Numériques
165 Rue Yves Chauvin - Node Park Touraine - 37310 TAUXIGNY - FRANCE
Tél. : +33 2 47 43 25 00 - Fax : +33 2 47 43 25 01