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REGISTRATION FORM J. DE CLERCK CHAIR XIII September 7 - 10 2008 - Louvain-la-Neuve, Belgium WEBSITE : www.declerckchair.com Email adress : firstname.lastname@example.org Family and First names Company / organization Profession / Title Mailing address Country Phone Fax e-mail I will travel by Car Plane Train REGISTRATION FEES Before August 15th 525 EURO including farewell dinner After August 15th 575 EURO LUNCH TICKETS In a set for 3 days 65 EURO YES NO Extra Farewell Dinner 60 EURO PAYMENT For registration fees EURO For lunch tickets EURO For extra farewell dinner EURO Total EURO Payment should be made in advance by means of transfer to : FORTIS banque B-1000 Brussels - Belgium Account number 210-0101547-40 IBAN : BE02 2100 1015 4740 Remittances should be free of bank charges to the receiver. BIC : GEBABEBB I should like to receive an invoice YES HOTEL RESERVATION - HAS TO BE DONE BY THE PARTICIPANTS We reserved rooms at the following hotel : Hotel Mercure Louvain-la-Neuve, boulevard de Lauzelle 61 - 1348 Louvain-la-Neuve Hotel rate, single + breakfast : 92€ per night Hotel rate, double + breakfast : 104€ per night Tel.: +3210450751 Fax : +3210450911 Email : H2200-SB1@accor.com Please, book your room latest August 15th, referring to the J.De Clerck Chair I booked a room at hotel mercure YES NO SEND YOUR COMPLETED REGISTRATION BY Email to email@example.com For more information,please contact the secretaries of the Chair : Sabine Bailly & Aurore Timmermans Email : firstname.lastname@example.org Fax: +3210472178 IMPORTANT NOTICE : The chair will be preceded by the BEER WEEK-END at the Grand Place of Brussels on September 5, 6 and 7.
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