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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

 

 

please fill the following form in PRINTED LETTERS.

BELGIUM • 1-6 APRIL 2003

EURO-AMERICAN NEW URBAN COUNCIL

Participant’s Full Name

……………………………………………………………………………………………………………………………………………………………………

Accompanying Spouse/Partner’s 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

Transportation & Visits

150 euros

Lunches (5) & Dinners (2) drink package included

215 euros

2 nights in Brussels (single room on a bed&breakfast basis)

260 euros

3 nights in Bruges (single room on a bed&breakfast basis)

395 euros

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

 

 

 

300 euros

 

125 euros

90 euros

70 euros

160 euros

Sub-Total

Cancellation Insurance

4% of the Sub-Total

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.

 

 

 

 

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.