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Registration + pay form - the 9th IPS Conference (September 11-14 2012)

Logo UHasselt Universiteit Hasselt - Knowledge in action

REGISTRATION + PAY FORM - THE 9TH IPS CONFERENCE (SEPTEMBER 11-14 2012)

 
  Surname : (*)
  First name : (*)
  Institute/company : (*)
  Street : nr : bus : (*)
  Postal code :  City:  (*) 
  State :
  Country : (*)
  E-mail : (*)

  I'm a:(*)

Student   (proof of enrollment required)

IPS member  

Non-IPS member  


  Register for conference dinner with
  beer tasting :

Yes   No   (€50 per person) (*)


 
Vegetarian meal : Yes   No   

  Accompanying person : person(s) (€50 per person) (*)
 
  Register for workshop : (€20 per person) (*)
  Accompanying person : person(s) (€20 per person) (*)

  Register for visit to the jenevermuseum :

Yes   No   (no additional fee) (*)


  Register for daytrip :

(fee determined by # participants) (*)

  Payment method : Bank transfer   Online Payment   (*)


  Total amount to be paid :
(*)mandatory fields