CLEC Registration Form - April 17, 2008

Name* :
First Name* :
Company* :
Function* :
Number* :		Street* :
Post Code* :		Town* :
Country* :
Phone Number* :
Fax Number :
e-Mail Address* :
VAT Number* :			(Indicate "N/A" if you aren't liable for VAT)
ISPA member :	Yes No
*=mandatory field

Participation fee
100€ (Drinks and sandwiches included)

Reductions
ISPA Members: 1 free invitation + 50€ for all additional subscriptions
Non Members: 100€ + 75€ for all additional subscriptions
Former DTIC-students and doctoral students: 75€

You will receive a confirmation of your registration by mail and an invoice by post in a few days

Thank you for waiting for the invoice before paying

Nous utilisons les données fournies par vous exclusivement à des fins administratives. Il vous est loisible de les consulter et si nécessaire, de les faire adapter (loi du 8/12/92 sur la protection de la vie privée).

Rempart de la Vierge 5 - 5000 Namur - Tel. +32 (0)81 725204 - Fax. +32 (0)81 725202