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Fields marked with * are required fields.
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Title: |
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*First Name: |
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*Last Name: |
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*Department/Institute: |
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*Street: |
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*Number: |
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*Postal code: |
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*City: |
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*Country: |
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*Email: |
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*Phone: |
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Fax:
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*I will present a paper: |
Yes | |
No |
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*Fee: |
regular | |
students without salary |
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Early registration fee (until 31 March) |
200 | |
100 |
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Fee after 1 April 2008 |
230 | |
130 |
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*I prefer the following type of lunch (included in the registration fee): |
regular | |
vegetarian |
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| Social programme |
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*I will attend the reception on Wednesday 16 July 2008 (6.30 pm) (included in the registration fee): |
yes | |
no |
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*I wish to attend the conference dinner on Friday 18 July 2008 (7.30 pm) (45 Euros): |
yes | |
no |
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regular | |
vegetarian |
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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.
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*Antwerp - Ghent |
yes | |
no |
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*Namur - Dinant |
yes | |
no |
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| Total amount due: |
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| Payment |
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*Payment is by credit card (VISA/Mastercard only) or by bank transfer. Please indicate your preferred form of payment: |
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I have faxed my credit card details* to +3216324767 (attn. Hubert Cuyckens) |
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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 |
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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 |
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* 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)
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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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