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8th December 2011 - afternoon
Hôtel le Meridien
Carrefour de l'Europe, 3
1000 Bruxelles
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3
seats left
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1-Your CONTACT INFORMATION
Name
*
:
Firstname
*
:
Email
*
:
Phone :
GSM :
Language
*
:
FR
NL
UK
Function
*
:
Company
*
:
Street
*
:
NR/Box
*
:
Postal Code
*
:
City
*
:
VAT number BE 0
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Entry fee
350 Euros
(Excl.VAT)
295 Euros
(Excl.VAT) if IAB/Feweb/BeCommerce /BDMA member.
Corporate conditions (more than 3 seats) please contact
Lieven
Member of:
I'm a member IAB
Yes
No
I'm a member Feweb
Yes
No
I'm a member BeCommerce
Yes
No
I'm a member BDMA
Yes
No
2-Contact information of your guest
Name :
Firstname :
Company :
Function :
3-INVOICING ADRESS (only if different from above)
Street :
NR/box :
Postal Code :
City :
4-PAYMENT
I pay by credit card (secured payment)
I would like to pay by bank transfer.
