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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 : declerckchair@uclouvain.be

 Family and First names
 Company / organization
 Profession / Title

 Mailing address


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                                       declerckchair@uclouvain.be
For more information,please contact the secretaries of the Chair : Sabine Bailly & Aurore Timmermans
       Email : declerckchair@uclouvain.be                          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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