Production, Perception, Attitude: 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 (either oral presentation or poster):  Yes  No
*Fee:  regular  students without salary
  130 €  110 €
*I prefer the following type of lunch (included in the registration fee):  regular  vegetarian
*I will attend the reception on Thursday 1 April 2009 (7 pm) (included in the registration fee):  yes  no
Total amount due:   ———  
Payment      
*Payment is by bank transfer or cash on site. Please indicate your preferred form of payment:    
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 400/0002/52441    
I pay cash on site    

 
* 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
BE 3000 Leuven, Belgium

IMPORTANT!
When making your payment, please quote the following number sequence as reason of payment:
400/0002/52441

For transfers from within Belgium:

Bankrekening nr.: 734-0066603-70

IMPORTANT!
When making your payment, please quote the following number sequence as reason of payment:
400/0002/52441