Below you can find your registration information including the total price. Note that your registration will only be fully completed after we received the bank transfer (or Paypal) for the required amount. Kind regards and we hope you enjoy the conference!, Organizing Committee -------------------------------------------- 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 : Please choose a number... 0 1 2 3 4 person(s) (€50 per person) (*) Register for workshop : Make your choice... workshop 1 workshop 2 no preference no workshop (€20 per person) (*) Accompanying person : Please choose a number... 0 1 2 3 4 person(s) (€20 per person) (*) Register for visit to the jenevermuseum : Yes No (no additional fee) (*) Register for daytrip : Make your choice... daytrip 1 daytrip 2 no preference no daytrip (fee determined by # participants) (*) Payment method : Bank transfer Online Payment (*) Payment by bank transfer: Name and address Accountholder: Universiteit Hasselt Agoralaan – Gebouw D B – 3590 Diepenbeek België Bank: Fortis Bank Bank address: Warandeberg 3 B – 1000 Brussel Belgium IBAN: BE77 0010 1870 7942 BIC (SWIFT) code: GEBABEBB Reference: SYMPPHYTO + First and Last Name Total amount to be paid : (*)mandatory fields
