Please fill out the form below deleting what is by Noodlezs

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									Please fill out the form below, deleting what is not applicable, and and return to:

Adriaan van der Weel
Leiden Centre for the Book
Leiden University
P.O. Box 9515
2300 RA Leiden, Netherlands

First name:
Surname:
Affiliation:
Postal address:
Place:
Postal (Zip) Code:
Country:
Email:

I should like to attend the conference "Digital access to book trade archives", at the National
Library, The Hague, the Netherlands, 31 May and 1 June 2001.

I shall be attending both days / the first day only / the second day only.

I am making the following payments:

         Registration: Dfl 90
         (Optional) Dinner on 31 May: Dfl 60
         (Optional) Dinner on 1 June: Dfl 60
         (Optional) Bank charges (see below): Dfl 25
Total:

Please indicate method of payment:
• I will pay the amount into bank account no 442287348 with ABN AMRO. Please mention
University of Leiden, Faculty of Arts and make sure you quote order number 1506021011. (NB:
for international payments bank charges of f 25 apply for this method of payment).
• I am paying by Eurocheque (enclosed)
• Please charge my Visa credit card number:

Expiry date:

Name on card:

for the total amount indicated above.

Place:

Date:

Signed:

								
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