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OFFICIAL ORGANISER : BLUEFIELD b.v.b.a. Boulevard Emile Jacqmainlaan 6 B-1000 Brussels Belgium Tel +32.2.218.46.80 Fax +32.2.217.76.90 License A5204 TVA/BTW/GST/VAT BE 470.820.677
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please fill the following form in PRINTED LETTERS.
BELGIUM 1-6 APRIL 2003 |
EURO-AMERICAN NEW URBAN COUNCIL |
Participants Full Name
Accompanying Spouse/Partners Full Name
.. .. ..
Address
City Zipcode .. Country .
Tel Fax Email
The following prices include VAT 21% and all other local taxes and services.
Registration |
300 euros |
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Transportation & Visits |
150 euros |
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Lunches (5) & Dinners (2) drink package included |
215 euros |
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2 nights in Brussels (single room on a bed&breakfast basis) |
260 euros |
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3 nights in Bruges (single room on a bed&breakfast basis) |
395 euros |
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Accompanying Spouse/Partner Supplement* * All Council session attendees must pay registration fee. Transportation & Visits Lunches (5) Dinners (2) 2 nights in Brussels : supplement for bed and breakfast 3 nights in Bruges : supplement for bed and breakfast |
150 euros
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300 euros
125 euros 90 euros 70 euros 160 euros |
Sub-Total |
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Cancellation Insurance |
4% of the Sub-Total |
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Total |
This registration is subject solely to Belgian law and any dispute shall be settled either in the French or Dutch language by the courts of the jurisdictional area of Brussels. |
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I hereby authorize BLUEFIELD to debit by credit card for the total amount of EURO
Card Type?VISA?AMERICAN EXPRESS ?MASTERCARD?DINERS CLUB
CARD Nr |___|___|___|___| |___|___|___|___| |___|___|___|___| |___|___|___|___|
Last 3 digits on the back your card |___|___|___| Expiry date |___|___| / |___|___|
SIGNATURE DATE
Please return this form signed by fax to:
from Europe: 00 32 2 217 76 90
Fax from US: 011 322 217 76 90
Telephone from Europe 00 32 2 218 46 80
Telephone from US: 011 322 218 46 80
E-mailsven@bluefield.be
THIS REGISTRATION FORM MUST BE FAXED SIGNED TO GUARANTEE A SEAT AT THE EURO-AMERICAN NEW URBAN COUNCIL AND HOTEL ROOM.