ACTE Executive Forum

Registration Form

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

Name

Title

Company/Affiliation

Address

Address*

City

State/Province*

Zip/Postal Code

Country

Telephone

Facsimile*

E-Mail

Registration Fee:

ACTE Member 77 Euro
Non-Member 97 Euro
Non-Member Joining 306 Euro

Payment:

Cheque
American Express
Diners Club
Euro/MasterCard
Visa

Cardholder Name

Card Number

Expiration Date

(Note: If you require a copy of this registration please
print using your browser's print feature before submitting this form.)

You may submit this form online, fax: +32-2-743-1550 or mail: ACTE EMEA, 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 25 per registrant will be granted to requests
recieved in writing before or on 25 September 2001. No refund will be granted
after that date. Telephone cancellatinos will not be accepted)

2001 EMEA Executive Forum Sponsors