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Dear participant,

Thank you for your interest in our international courses. This form is the only way to subscribe. When you receive our confirmation, your registration is completed.

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The conference organisers

1. Surname:
2. (first) name (as mentioned on your passport):
3. Gender:
4. Date of birth:
5. Organisation (name and number for Flemish schools):
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6.  Street and number:
999 New Haven
7. Postal code & city:
8. Country:
9. Function in the organisation / profession:
10. Contact e-mail:
11. Contact e-mail again for verification:
12. Name and address to be mentioned on the invoice:
13. Special diet?:
13.a. If you have a special diet, please indicate which one::
13.b. If you have special requirements, please mention them here.:
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14. Date of arrival:
15. Date of departure:
16. I want to stay in:
a single room
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Created at 12/1/2020 8:49 PM by ***
Last modified at 12/1/2020 8:49 PM by ***