ACTE Executive Forum

Registration Form

All fields are required unless marked with a "*". Name, Title and Company will appear on badge as submitted.

Last Name, First Name

Title

Company/Affiliation

Address

Address*

City

State/Province*

Zip/Postal Code

Country

Telephone

Facsimile*

E-Mail

Registration Fee:

ACTE Member 210 Euro
Non-Member 315 Euro
Non-Member joining ACTE 470 Euro

Payment:

Check
American Express
Diners Club
MasterCard
Visa

Cardholder Name

Card Number

Expiration Date

(Note: To pay by check, please do not submit this form on-line.
Instead use your browser's print feature to print the completed form,
make written note that a check has been mailed, and fax it to +32-2-743-1550.
You should also print this form if you require a receipt of registration).

You may submit this form online, by Fax: +32-2-743-1550 or
Mail: ACTE Registration Office, Avenue Des Gaulois 7, B-1040 Brussels, Belgium.
You may call +32-2-743-1589 for questions or more information.
Full refund less a handling fee of Euro 50 per registrant will be granted to requests received in writing 1 week prior to the event.
No refunds will be granted for requests after that date. telephone cancellations will not be accepted.

Hotel Accommodations

Hotel Le Plaza
Bld. Adolphe Max 118-126
B-1000 Brussels
Belgium
T: +32-22276700
F: +32-22276720
www.leplaza-brussels.be

By mentioning ACTE you will be offered a special rate of Euro 125. Please make your reservations before June 1st,
after June first the special rate might not be guaranteed.
Please contact the hotel directly at +32-22276734 or via e-mail at [email protected].

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