NRG4
K.U.Leuven
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Nrg4 :: Registration
 

Fields marked with * are required fields.

Title: 
*First Name: 
*Last Name: 
*Department/Institute: 
*Street:  *Number: 
*Postal code:  *City: 
*Country: 
*Email: 
*Phone: 
Fax: 

*I will present a paper:  Yes  No

*Fee:  regular  students without salary
Early registration fee (until 31 March) 200  100
Fee after 1 April 2008 230  130

*I prefer the following type of lunch (included in the registration fee):  regular  vegetarian

Social programme      
*I will attend the reception on Wednesday 16 July 2008 (6.30 pm) (included in the registration fee):  yes  no
*I wish to attend the conference dinner on Friday 18 July 2008 (7.30 pm) (45 Euros):  yes  no
  regular  vegetarian
I intend to take part in the post-conference excursion on Sunday 20 July 2008 and would like to receive more information about the detailed program, price, and form of payment.    
*Antwerp - Ghent yes  no
*Namur - Dinant yes  no

Total amount due:   ———  

Payment      
*Payment is by credit card (VISA/Mastercard only) or by bank transfer. Please indicate your preferred form of payment:    
I have faxed my credit card details* to +3216324767 (attn. Hubert Cuyckens)    
I have sent my credit card details* by post to Hubert Cuyckens, Dept of Linguistics, PO Box 3308, Blijde-Inkomststraat 21, B-3000 Leuven, Belgium    
I have transferred the total amount due to the following bank account: IBAN BE60 7340 0666 0370, BIC/Swift code: kredbebb; account holder: University of Leuven, Krakenstraat 3, 3000 Leuven, Belgium, quoting 400/0001/12803    

 
* Credit card details include:
- name and address of credit card holder
- credit card number
- expiry date
- CVS number (last three numbers from back of card)

------------------------------------------------------------------------------
Payment by bank transfer: Please transfer the total amount to:

For transfers from abroad:

IBAN no. BE60 7340 0666 0370
BIC/SWIFT Code: kredbebb
Address of bank:
K.B.C.-Bank
Bedrijvenkantoor Leuven
Brusselsesteenweg 100
B-3000 Leuven, Belgium

When making your payment, please quote the following number sequence as reason of payment:
400/0001/12803.

For transfers from within Belgium:

Bankrekening nr.: 734-0066603-70.

When making your payment, please quote the following number sequence as reason of payment:
400/0001/12803.





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Production: Dirk Speelman | Most recent update: Oktober 24, 2007
URL: http://wwwling.arts.kuleuven.be/nrg4