CORDIS Archive

EITC 97
REGISTRATION & ACCOMMODATION FORM

---

Please print out this form, complete it in CAPITALS, and fax or post it to the Administrative Secretariat. For additional attendees, please photocopy this form.

Administrative Secretariat
E.C.C.O. (European Congress Consultants & Organisers)
Rue de l'Abbaye, 27a Abdijstraat
B-1050 Brussels, Belgium
fax+32-2-640-66-97- tel+32-2-647-87-80-email v.wouters@ecco-congress.be

---

Title (please tick or circle one): Prof Dr Ir Ms Mr Mrs

Surname:________________________________________________________________________________

First Name:_______________________________________________________________________

Organisation:______________________________________________________________________________

Department:______________________________________________________________________________

Address:_________________________________________________________________________________

________________________________________________________________________________________

Postal/Zip Code:__________________________City:_____________________________________

Country:_____________________________________________________________________________

Tel:__________________________________________Fax:__________________________________________________

E-mail:___________________________________________

Web: http://________________________________________

---

Registration fee (in Belgian francs)

Please tick or circle choice	Early registration before 17 October	Late registration from 17 October	On-site registration
24, 25 & 26 November **	15500	17500	19500
24 & 25 November	13000	15000	17000
26 November **	5000	6000	7000

---

Lunches on Monday and Tuesday
The price for each lunch on each day is 1000 Belgian francs, payable in advance.
Please indicate on which day or days you require lunch:

• Monday 24 November (1000 Belgian francs)
• Tuesday 25 November (1000 Belgian francs)

Lunch on Wednesday
** The fee for 24, 25 and 26 November, and the fee for 26 November, includes a light lunch on 26 November. Pre-registration for this lunch is required, please tick or circle one option :

will attend lunch / will not attend lunch

---

Accommodation (see the list of hotels where special rates are available)

Single room / double room (please indicate which)

1st choice of reservation_________________________________________________ (name of hotel)

2nd choice of reservation________________________________________________ (name of hotel)

Date of arrival:______________NovemberDate of departure:_____________November

Deposit: ___________________ Belgian francs

---

Payment method (please indicate which method you are using)

• I enclose a cheque/eurocheque/banker's draft payable to "EITC97" (enclosed)
• I will transfer to your account no. 310-1201526-73 at Bank Bruxelles-Lambert
• Please charge my credit card
  (please indicate which type of card you are using)

• VISA
• EUROCARD/MASTERCARD
• AMERICAN EXPRESS
• DINERS CLUB

  Card number ___________________________________________________

  Expiry date __________

  Name on card ___________________________________

  Signature of holder____________________

Payment check-list

• Registration fee
• Reservation of accommodation
• Lunch(es)

If you fax this form, please post the original together with your remittance!

---

EITC 97 home page | Full programme overview | Esprit home page

This document is located at /esprit/src/regfrm97.htm
It was last updated on 12 August 1997, and is maintained by the EITC 97 Secretariat - eitc97@dg3.cec.be