CONFERENCE REGISTRATION FORM

Company/organisation   Department   Address   City   Postal code   Country       1st Participant   First name       Prof. Dr. Mr. Mrs. Ms. Last name   Tel.   Fax   E-mail address Obligatory for on-line submitting       2nd Participant*)   First name       Prof. Dr. Mr. Mrs. Ms. Last name   Tel.   Fax   E-mail address Obligatory for on-line submitting

Fee All prices include 19% VAT.

paid by 01/12/2009 paid after 01/12/2009 Full conference fee  EUR 685  EUR 800 Discounted registration fee (universities)  EUR 450  EUR 565 *) Special registration fee  EUR 420  EUR 420

2nd Participant from the same company/organisation registering at the same time and paying in one payment together with the 1st participant

Conference dinner, 1st participant  EUR 50  EUR 50 Conference dinner, 2nd participant  EUR 50  EUR 50

Billing address (if different from above mentioned address)

Company/organisation   Department   Address   City   Postal code   Country   Purchase order number (if applicable):

Registration and payment Please note: Registrations are only accepted after receipt of the completed Conference Registration Form AND payment! Payment should be made by bank transfer, free of all bank charges and commission, to: account name 'TNO Kwaliteit van Leven'; account no. 68 76 71 906 at ING Bank, Schenkkade 65, The Hague, the Netherlands (BIC/Swift code: INGBNL2A; IBAN: NL 06 INGB 0687 6719 06). Please state the participant's name and 'BMC' on the bank transfer. Registration will be confirmed by means of the Confirmation of Payment & Invoice, which will automatically be sent to you upon receipt of the registration fee. Cancellation Refunds, minus EUR 150.- administrative charge, will be made for cancellations received up to 15 February 2010. Cancellations are only valid if notice is received in writing. For cancellations made after 15 February 2010 no refunds will be paid. However, a participant may designate a substitute delegate.

 

Secretariat

Bastiaanse Communication, P.O. Box 179, NL-3720 AD Bilthoven, the Netherlands

T +31 30 2294247, F +31 30 2252910, BM@bastiaanse-communication.com