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Please print, complete and return this form by fax to
09/241.56.56
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Faxback Registration Form
Company Information
Company Name
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......................................................
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Address
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......................................................
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ZIP code + City
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......................................................
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Country
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......................................................
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VAT number
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......................................................
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Purchase Order
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....................................... (optional)
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Invoice address is [ ... ] the same, or:
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Address
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......................................................
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ZIP code + City
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......................................................
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Country
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......................................................
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This registration was made by:
Name
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[ ... ] Mr.
[ ... ] Mrs.
......................................................
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Job title
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.....................................
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Email
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......................................................
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Phone
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.....................................
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Fax
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.....................................
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Participant(s)
Name
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[ ... ] Mr.
[ ... ] Mrs.
......................................................
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Job title
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.....................................
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Email
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......................................................
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Dietary
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[ ... ] no meat
[ ... ] no fish
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Name
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[ ... ] Mr.
[ ... ] Mrs.
......................................................
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Job title
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.....................................
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Email
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......................................................
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Dietary
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[ ... ] no meat
[ ... ] no fish
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Name
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[ ... ] Mr.
[ ... ] Mrs.
......................................................
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Job title
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.....................................
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Email
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......................................................
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Dietary
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[ ... ] no meat
[ ... ] no fish
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Seminars
Registrant agrees with the seminar conditions and registers the above participant(s) for the seminar(s):
Payment
[ ... ] Payment upon receipt of invoice
Signature .........................................................................
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Date ................................................................. |
Your data will be recorded in the database of I.T. Works bvba, Technologiepark 3, 9052 Gent, so that we can keep you informed about our
activities. In accordance with the law of 8/12/1992 on the protection of privacy, you can
inspect and, if necessary, correct this data.
Uw gegevens worden in een bestand opgenomen door I.T. Works bvba, Technologiepark 3, 9052 Gent,
zodat wij u op de hoogte kunnen houden van onze aktiviteiten. Overeenkomstig de wet van
8/12/1992, heeft u recht op inzage, correctie of schrapping ervan.
I.T. Works, Technologiepark 82, 9052 Gent (Belgium), Phone: (09) 241.56.13
- Fax: (09) 241.56.56 - E-Mail: seminars@itworks.be - URL: http://www.itworks.be/
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